Provider Demographics
NPI:1720651003
Name:BENADE, ROSINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ROSINA
Middle Name:ELIZABETH
Last Name:BENADE
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 1:121 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-6554
Mailing Address - Country:US
Mailing Address - Phone:210-362-4854
Mailing Address - Fax:
Practice Address - Street 1:THE VILLAGE OF INCARNATE WORD
Practice Address - Street 2:4707 BROADWAY ST
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-673-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214083224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification