Provider Demographics
NPI:1295834752
Name:BENEMERITO, MARWYN GARIBAY (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARWYN
Middle Name:GARIBAY
Last Name:BENEMERITO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 WILLOW TREE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3106
Mailing Address - Country:US
Mailing Address - Phone:901-309-5219
Mailing Address - Fax:901-309-5265
Practice Address - Street 1:895 WILLOW TREE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3106
Practice Address - Country:US
Practice Address - Phone:901-309-5219
Practice Address - Fax:901-309-5265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4128796OtherBCBS OF TN PIN
TN4290875OtherBCBS PIN
TN7536487OtherAETNA PIN