Provider Demographics
NPI:1033425954
Name:BEAVERS, KAREN GOODMAN (MED, ITFS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GOODMAN
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:MED, ITFS
Other - Prefix:
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Mailing Address - Street 1:307 S SALEM ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1845
Mailing Address - Country:US
Mailing Address - Phone:919-418-7175
Mailing Address - Fax:919-355-1551
Practice Address - Street 1:307 S SALEM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1845
Practice Address - Country:US
Practice Address - Phone:919-418-7175
Practice Address - Fax:919-355-1551
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist