Provider Demographics
NPI:1487764346
Name:MARWYN G BENEMERITO
Entity type:Organization
Organization Name:MARWYN G BENEMERITO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARWYN
Authorized Official - Middle Name:GARIBAY
Authorized Official - Last Name:BENEMERITO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:901-309-5219
Mailing Address - Street 1:1044 CROSS WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6604
Mailing Address - Country:US
Mailing Address - Phone:901-309-5219
Mailing Address - Fax:901-309-5265
Practice Address - Street 1:146 TIMBER CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4234
Practice Address - Country:US
Practice Address - Phone:901-309-5219
Practice Address - Fax:901-309-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2379235Z00000X
TN3275235Z00000X
TN3892225XP0200X
TN5112225100000X
TN3278235Z00000X
TN955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441022Medicaid
TN4128794OtherBCBS OF TN