Provider Demographics
NPI:1194242511
Name:BENAVIDEZ, LAURA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
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 1:3520 EXECUTIVE CENTER DR STE 128
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1636
Mailing Address - Country:US
Mailing Address - Phone:512-343-0222
Mailing Address - Fax:
Practice Address - Street 1:3520 EXECUTIVE CENTER DRIVE
Practice Address - Street 2:SUITE 128
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-343-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
115341225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics