Provider Demographics
NPI:1346729894
Name:BECKENDORF, SAUNDRA
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:BECKENDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 ACR 473
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75861
Mailing Address - Country:US
Mailing Address - Phone:903-245-8145
Mailing Address - Fax:
Practice Address - Street 1:4880 ACR 473
Practice Address - Street 2:
Practice Address - City:TENNESSEE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75861
Practice Address - Country:US
Practice Address - Phone:903-245-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213061224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant