Provider Demographics
NPI:1699455345
Name:ZENTNER, BENJAMIN ALAN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ALAN
Last Name:ZENTNER
Suffix:
Gender:M
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 1:9920 SW CONESTOGA DR APT 201
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8434
Mailing Address - Country:US
Mailing Address - Phone:512-944-4890
Mailing Address - Fax:
Practice Address - Street 1:601 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2910
Practice Address - Country:US
Practice Address - Phone:503-982-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR450884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist