Provider Demographics
NPI:1639544604
Name:ANGELA BENZ
Entity Type:Organization
Organization Name:ANGELA BENZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:859-481-2916
Mailing Address - Street 1:1535 TATUM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLISBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40078-8241
Mailing Address - Country:US
Mailing Address - Phone:859-481-2916
Mailing Address - Fax:
Practice Address - Street 1:1535 TATUM RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLISBURG
Practice Address - State:KY
Practice Address - Zip Code:40078-8241
Practice Address - Country:US
Practice Address - Phone:859-481-2916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty