Provider Demographics
NPI:1457984007
Name:BENAVIDES, DAVID HECTOR (OTR)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HECTOR
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 BUENA PARK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7949
Mailing Address - Country:US
Mailing Address - Phone:262-903-1504
Mailing Address - Fax:
Practice Address - Street 1:10340 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1607
Practice Address - Country:US
Practice Address - Phone:262-687-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty