Provider Demographics
NPI:1346978087
Name:GERMOLUS, BENJAMIN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:GERMOLUS
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3340
Mailing Address - Country:US
Mailing Address - Phone:320-639-4528
Mailing Address - Fax:320-693-4561
Practice Address - Street 1:612 S SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3340
Practice Address - Country:US
Practice Address - Phone:320-693-4528
Practice Address - Fax:320-693-4561
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist