Provider Demographics
NPI:1538418041
Name:BENAVIDEZ, DANIEL (COTA, ATP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BENAVIDEZ
Suffix:
Gender:M
Credentials:COTA, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-6595
Mailing Address - Country:US
Mailing Address - Phone:956-998-8234
Mailing Address - Fax:
Practice Address - Street 1:232 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2920
Practice Address - Country:US
Practice Address - Phone:956-682-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89411247200000X
TX211741224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other