Provider Demographics
NPI:1013558568
Name:BEACHAM, AMANDA PRESTER (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PRESTER
Last Name:BEACHAM
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 1:3575D MAYBANK HWY # 235
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4823
Mailing Address - Country:US
Mailing Address - Phone:843-900-6202
Mailing Address - Fax:843-574-8858
Practice Address - Street 1:45 SYCAMORE AVE APT 917
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6729
Practice Address - Country:US
Practice Address - Phone:843-900-6202
Practice Address - Fax:843-574-8858
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5661225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology