Provider Demographics
NPI:1023277407
Name:BENESH, KRISTIN BETH (COTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BETH
Last Name:BENESH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ROOT DR SE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:52209-9700
Mailing Address - Country:US
Mailing Address - Phone:319-981-9295
Mailing Address - Fax:
Practice Address - Street 1:1305 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1305
Practice Address - Country:US
Practice Address - Phone:360-736-2823
Practice Address - Fax:360-736-7085
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant