Provider Demographics
NPI:1164066411
Name:BECKER, BEVERLEY MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:MICHELLE
Last Name:BECKER
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 1:2828 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-6045
Mailing Address - Country:US
Mailing Address - Phone:561-452-6981
Mailing Address - Fax:
Practice Address - Street 1:2828 NW 30TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-6045
Practice Address - Country:US
Practice Address - Phone:561-452-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10752224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant