Provider Demographics
NPI:1245342211
Name:BENEN, SANDRA LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:BENEN
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 1:5070 PALMETTO WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-2814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2960 IMMOKALEE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1439
Practice Address - Country:US
Practice Address - Phone:239-514-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10193225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics