Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 057005256 |
NPI | 1225789761 |
---|---|
Provider Name | Sharmisha Benjamin |
First Address | Colp, IL 62918 |
Second Address | Herrin, IL 62948-6294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2022 |
Last Update Date | 17/01/2022 |