Provider Demographics
NPI:1497511018
Name:BENNER, CHELSEY MARIE (OTR)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:MARIE
Last Name:BENNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:MARIE
Other - Last Name:LAMONICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:715-235-9671
Mailing Address - Fax:
Practice Address - Street 1:2321 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-7003
Practice Address - Country:US
Practice Address - Phone:715-235-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2025-02-24
Deactivation Date:2024-02-22
Deactivation Code:
Reactivation Date:2024-05-31
Provider Licenses
StateLicense IDTaxonomies
WI8512-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist