Provider Demographics
NPI:1861827107
Name:BENSON, ANASTASIA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:MARIE
Last Name:BENSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25371 CALVERT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21639-1241
Mailing Address - Country:US
Mailing Address - Phone:410-714-0295
Mailing Address - Fax:
Practice Address - Street 1:100 ENTERPRISE PL
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8202
Practice Address - Country:US
Practice Address - Phone:302-678-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001201172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker