Provider Demographics
NPI:1942522867
Name:BENECK, AMY LEEANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEEANN
Last Name:BENECK
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 1:10981 MEADS
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2112
Mailing Address - Country:US
Mailing Address - Phone:714-322-7510
Mailing Address - Fax:
Practice Address - Street 1:10981 MEADS
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2112
Practice Address - Country:US
Practice Address - Phone:714-322-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6418225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics