Provider Demographics
NPI:1558453506
Name:BENJAMIN, KAY D (OTR)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:D
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2603 HTN, CLIENT ACCOUNTING
Mailing Address - Street 2:
Mailing Address - City:FT. WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:
Practice Address - Street 1:3840 HULEN ST HTN, CLIENT ACCOUNTING
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115132225X00000X
NM2573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
886T09OtherBCBS
TX311991901Medicaid
AZ770017Medicaid