Provider Demographics
NPI:1891974150
Name:BENTHUSEN, HOLLI (OT)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:
Last Name:BENTHUSEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446
Mailing Address - Country:US
Mailing Address - Phone:352-382-0939
Mailing Address - Fax:352-382-4297
Practice Address - Street 1:8455 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446
Practice Address - Country:US
Practice Address - Phone:352-382-0939
Practice Address - Fax:352-382-4297
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist