Provider Demographics
NPI:1235578147
Name:BEAVER, GAIL K (OTR/L)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:K
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:1800 COPPER LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-8139
Mailing Address - Country:US
Mailing Address - Phone:575-524-2575
Mailing Address - Fax:575-523-1756
Practice Address - Street 1:2325 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3902
Practice Address - Country:US
Practice Address - Phone:575-527-4900
Practice Address - Fax:575-523-1756
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2712225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics