Provider Demographics
NPI:1902189947
Name:BENJAMIN, EMILY NILSSON (COTA/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NILSSON
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:VICTORIA
Other - Last Name:NILSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:55 HOLCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9639
Mailing Address - Country:US
Mailing Address - Phone:864-580-9186
Mailing Address - Fax:
Practice Address - Street 1:55 HOLCOMBE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-9639
Practice Address - Country:US
Practice Address - Phone:864-612-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2912224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant