Provider Demographics
NPI:1518112879
Name:BEAGLE, LINDA MAE (OT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:BEAGLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20107 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-8674
Mailing Address - Country:US
Mailing Address - Phone:360-903-7482
Mailing Address - Fax:
Practice Address - Street 1:100 E 33RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-903-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002037225X00000X
OR584447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist