Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | RBT-19-80902 | UT |
Y | 225X00000X | Occupational Therapist | 9834370-4201 | UT |
N | 225XM0800X | Mental Health | ||
N | 225XM0800X | Mental Health | 9834370-4201 | UT |
N | 225XP0200X | Occupational Therapist - Pediatrics | 9834370-4201 | UT |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT-1654 | ID |
NPI | 1477008340 |
---|---|
Provider Name | Mrs. Courtney Lynne Benner |
First Address | Orem, UT 84097 |
Second Address | Orem, UT 84097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2016 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225X00000X | (05) | ID |
3008546 | (05) | UT |