Provider Demographics
NPI:1497063234
Name:LEWIS, BEVERLY D (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DEBS PL APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2565
Mailing Address - Country:US
Mailing Address - Phone:718-379-7228
Mailing Address - Fax:
Practice Address - Street 1:1887 BATHGATE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6216
Practice Address - Country:US
Practice Address - Phone:718-466-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006152-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant