Provider Demographics
NPI:1356462352
Name:FORSTER, BEVERLEE TYLER (OTRL)
Entity Type:Individual
Prefix:
First Name:BEVERLEE
Middle Name:TYLER
Last Name:FORSTER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-6853
Mailing Address - Country:US
Mailing Address - Phone:570-437-2933
Mailing Address - Fax:
Practice Address - Street 1:615 SMITH RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-6853
Practice Address - Country:US
Practice Address - Phone:570-437-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006239L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC006239LOtherPA LICENSE