Provider Demographics
NPI:1083686851
Name:BENO, ANDREA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BENO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MALECHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8830 NORMANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1051
Mailing Address - Country:US
Mailing Address - Phone:952-758-5775
Mailing Address - Fax:952-758-5778
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-758-5775
Practice Address - Fax:952-758-5778
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FMHP43201OtherMN HEALTHPARTNERS NUMBER
MN685S7MAOtherMN BCBS NUMBER
MN7616187OtherMN AETNA NUMBER