Provider Demographics
NPI:1962812560
Name:BENIGNO-TESORIERO, LORLIE
Entity Type:Individual
Prefix:
First Name:LORLIE
Middle Name:
Last Name:BENIGNO-TESORIERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 5TH AVE APT C4
Mailing Address - Street 2:SUITE C4
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6393
Mailing Address - Country:US
Mailing Address - Phone:772-380-3502
Mailing Address - Fax:
Practice Address - Street 1:921 5TH AVE APT C4
Practice Address - Street 2:SUITE C4
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6393
Practice Address - Country:US
Practice Address - Phone:772-380-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60338983225X00000X
FL3278225X00000X
NM4608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist