Provider Demographics
NPI:1376001008
Name:TALBOT, BENJAMIN HARL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:HARL
Last Name:TALBOT
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 1:170 COUNTRYSIDE LN APT 7
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1356
Mailing Address - Country:US
Mailing Address - Phone:860-986-3696
Mailing Address - Fax:
Practice Address - Street 1:170 COUNTRYSIDE LN APT 7
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1356
Practice Address - Country:US
Practice Address - Phone:860-986-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist