Provider Demographics
NPI:1851532873
Name:PEASE, BENJIE RUSSELL (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:BENJIE
Middle Name:RUSSELL
Last Name:PEASE
Suffix:
Gender:M
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FRANKLIN RD
Mailing Address - Street 2:STE 135A-102
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:760-256-2800
Mailing Address - Fax:760-256-2809
Practice Address - Street 1:1830 BICKFORD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1749
Practice Address - Country:US
Practice Address - Phone:360-568-7774
Practice Address - Fax:360-568-7779
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60078673225X00000X
WAOT60078673225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0326407OtherL & I
WA0326420OtherL & I
WA0326397OtherL & I
WAG8928616Medicare PIN
WAG8928626Medicare PIN
WAG8928627Medicare PIN