Provider Demographics
NPI:1063864940
Name:PROUSE, BEVERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:PROUSE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 BILMAR RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1002
Mailing Address - Country:US
Mailing Address - Phone:610-763-5182
Mailing Address - Fax:
Practice Address - Street 1:2609 BILMAR RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1002
Practice Address - Country:US
Practice Address - Phone:610-763-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001660L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant