Provider Demographics
NPI:1366760795
Name:BENJAMIN, AMY JILL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JILL
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BENJAMIN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:720-865-6072
Mailing Address - Fax:720-865-6072
Practice Address - Street 1:1550 S POTOMAC ST STE 180
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5448
Practice Address - Country:US
Practice Address - Phone:303-744-7078
Practice Address - Fax:303-777-4563
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002110300Medicaid