Provider Demographics
NPI:1578136362
Name:BECK, JARED THOMAS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:THOMAS
Last Name:BECK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1761
Mailing Address - Country:US
Mailing Address - Phone:816-263-5713
Mailing Address - Fax:
Practice Address - Street 1:505 N FILLMORE ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1761
Practice Address - Country:US
Practice Address - Phone:816-263-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014588225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics