Provider Demographics
NPI:1841507159
Name:BENAVIDEZ, MEGAN HARRISON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:HARRISON
Last Name:BENAVIDEZ
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 1:3144 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-9694
Mailing Address - Country:US
Mailing Address - Phone:662-523-3597
Mailing Address - Fax:
Practice Address - Street 1:3144 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-9694
Practice Address - Country:US
Practice Address - Phone:662-523-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist