Provider Demographics
NPI:1376233874
Name:IKIER, BEVERLEY J (BCTMB, CPT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:J
Last Name:IKIER
Suffix:
Gender:F
Credentials:BCTMB, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2100
Mailing Address - Country:US
Mailing Address - Phone:978-254-5620
Mailing Address - Fax:
Practice Address - Street 1:336 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2100
Practice Address - Country:US
Practice Address - Phone:978-254-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist