1679664841 NPI number — JERYL D. BENSON MS, OTR/L

Table of content: JERYL D. BENSON MS, OTR/L (NPI 1679664841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679664841 NPI number — JERYL D. BENSON MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENSON
Provider First Name:
JERYL
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679664841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 FISHER HALL
Provider Second Line Business Mailing Address:
600 FORBES AVENUE
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15282-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-396-4200
Provider Business Mailing Address Fax Number:
412-396-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 FISHER HALL
Provider Second Line Business Practice Location Address:
711 FORBES AVENUE
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15282-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-396-4200
Provider Business Practice Location Address Fax Number:
412-396-1388
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC002735L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 698540 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 698542 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".