Provider Demographics
NPI:1225073612
Name:BEAVEN, BARBARA (OTA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BEAVEN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4432
Mailing Address - Country:US
Mailing Address - Phone:813-239-1179
Mailing Address - Fax:813-237-3091
Practice Address - Street 1:2215 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4432
Practice Address - Country:US
Practice Address - Phone:813-239-1179
Practice Address - Fax:813-237-3091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 9719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA 9719OtherOCCUPATIONAL THERAPY ASSI