Provider Demographics
NPI:1073884201
Name:BENSON, JODY LYNNE (OTR/L MS)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNNE
Last Name:BENSON
Suffix:
Gender:F
Credentials:OTR/L MS
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYNNE
Other - Last Name:BROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:2150 W GOLF RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5604
Practice Address - Country:US
Practice Address - Phone:847-755-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist