Provider Demographics
NPI:1588683577
Name:BLECHA, BENJAMIN WAYNE (CPO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WAYNE
Last Name:BLECHA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CHIEF ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-3065
Mailing Address - Country:US
Mailing Address - Phone:308-423-2690
Mailing Address - Fax:308-423-2691
Practice Address - Street 1:503 CHIEF ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-3065
Practice Address - Country:US
Practice Address - Phone:308-423-2690
Practice Address - Fax:308-423-2691
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO 2571225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter