Provider Demographics
NPI:1376699462
Name:BENOCK, THERESA CLARK (OTR,CHT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CLARK
Last Name:BENOCK
Suffix:
Gender:F
Credentials:OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12576 BACCHUS RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-1509
Mailing Address - Country:US
Mailing Address - Phone:941-698-1191
Mailing Address - Fax:
Practice Address - Street 1:3417 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:940-624-6222
Practice Address - Fax:941-624-6821
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1055225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand