Provider Demographics
NPI:1346874237
Name:BEARD, LARRY ALAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALAN
Last Name:BEARD
Suffix:
Gender:M
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 1:6 FIG ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1761
Mailing Address - Country:US
Mailing Address - Phone:636-249-3088
Mailing Address - Fax:
Practice Address - Street 1:311 N SPRING ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5089
Practice Address - Country:US
Practice Address - Phone:573-775-5815
Practice Address - Fax:573-775-4072
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012618224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty