Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003345463 |
---|---|
Provider Name | Sarah Benepe |
First Address | Coon Rapids, MN 55448-4378 |
Second Address | Coon Rapids, MN 55448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 16/06/2018 |