Basic Information
| Provider Information | |||||||||
| NPI: | 1851532873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEASE | ||||||||
| FirstName: | BENJIE | ||||||||
| MiddleName: | RUSSELL | ||||||||
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| Credential: | MOT OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 FRANKLIN RD | ||||||||
| Address2: | STE 135A-102 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370273280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602562800 | ||||||||
| FaxNumber: | 7602562809 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 BICKFORD AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605687774 | ||||||||
| FaxNumber: | 3605687779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2009 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 60078673 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OT60078673 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 0326407 | 01 | WA | L & I | OTHER | 0326420 | 01 | WA | L & I | OTHER | 0326397 | 01 | WA | L & I | OTHER |