Provider Demographics
NPI:1477449809
Name:BENZINE, BROOKLYNN MIKKEL
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:MIKKEL
Last Name:BENZINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S11892 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-9638
Mailing Address - Country:US
Mailing Address - Phone:608-556-6479
Mailing Address - Fax:608-556-6479
Practice Address - Street 1:501 S WINSTED ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-9435
Practice Address - Country:US
Practice Address - Phone:608-588-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7165-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant