Provider Demographics
NPI:1457475956
Name:BEARD, SHIRLEY (COTA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3811
Mailing Address - Country:US
Mailing Address - Phone:386-252-8935
Mailing Address - Fax:
Practice Address - Street 1:1309 LAUREL DR
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3811
Practice Address - Country:US
Practice Address - Phone:386-252-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA8814224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant