Provider Demographics
NPI:1841619202
Name:BENCHOUK, DJAMIL CLARK (COTA/L)
Entity Type:Individual
Prefix:
First Name:DJAMIL
Middle Name:CLARK
Last Name:BENCHOUK
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:CLARK
Other - Middle Name:
Other - Last Name:BENCHOUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:24 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2649
Mailing Address - Country:US
Mailing Address - Phone:267-261-0691
Mailing Address - Fax:
Practice Address - Street 1:701 LANSDALE AVE
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2958
Practice Address - Country:US
Practice Address - Phone:215-368-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant