Provider Demographics
NPI:1194788901
Name:BENSON, CORNELIA VON LERSNER (OTR/L;CHT)
Entity type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:VON LERSNER
Last Name:BENSON
Suffix:
Gender:F
Credentials:OTR/L;CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 COMMERCE DR STE B
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8200
Mailing Address - Country:US
Mailing Address - Phone:616-895-4770
Mailing Address - Fax:616-895-4774
Practice Address - Street 1:11301 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8200
Practice Address - Country:US
Practice Address - Phone:616-895-4770
Practice Address - Fax:616-895-4774
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010854225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty