Provider Demographics
NPI:1720430655
Name:BENGE, SHERRY RENAE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:RENAE
Last Name:BENGE
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 1:602 CLYDE BENGE RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8808
Mailing Address - Country:US
Mailing Address - Phone:606-682-9845
Mailing Address - Fax:
Practice Address - Street 1:602 CLYDE BENGE RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8808
Practice Address - Country:US
Practice Address - Phone:606-682-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist