Provider Demographics
NPI:1578726329
Name:BENITEZ BARZAGA, SUSEL (BS, MSOT)
Entity Type:Individual
Prefix:
First Name:SUSEL
Middle Name:
Last Name:BENITEZ BARZAGA
Suffix:
Gender:F
Credentials:BS, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 MCGILL ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7710
Mailing Address - Country:US
Mailing Address - Phone:305-431-3903
Mailing Address - Fax:
Practice Address - Street 1:2405 MERCER AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7441
Practice Address - Country:US
Practice Address - Phone:561-371-3277
Practice Address - Fax:561-355-4222
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016157400Medicaid