Provider Demographics
NPI:1871391664
Name:SNODGRASS, BENJAMIN CLARK (OTR/L)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CLARK
Last Name:SNODGRASS
Suffix:
Gender:
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:TOLONO
Mailing Address - State:IL
Mailing Address - Zip Code:61880-0003
Mailing Address - Country:US
Mailing Address - Phone:217-722-0404
Mailing Address - Fax:
Practice Address - Street 1:1540 E GROVE AVE
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-2736
Practice Address - Country:US
Practice Address - Phone:217-383-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist