Provider Demographics
NPI:1467625699
Name:HALL, BENITA WICKER (OT/L, PT, DPT)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:WICKER
Last Name:HALL
Suffix:
Gender:F
Credentials:OT/L, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 WADDELL CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8332
Mailing Address - Country:US
Mailing Address - Phone:919-323-1155
Mailing Address - Fax:919-596-8322
Practice Address - Street 1:1615 WADDELL CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8332
Practice Address - Country:US
Practice Address - Phone:919-323-1155
Practice Address - Fax:919-596-8322
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6020225X00000X
NCP11703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist