Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XM0800X | Mental Health |
NPI | 1134451792 |
---|---|
Provider Name | Terrance John Benovsky |
First Address | Chicago, IL 60634-1410 |
Second Address | Chicago, IL 60634-1410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2010 |
Last Update Date | 08/02/2010 |