Provider Demographics
NPI:1598169443
Name:FITZWILLIAM, BEVERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:FITZWILLIAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FINLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15332-9429
Mailing Address - Country:US
Mailing Address - Phone:412-563-5665
Mailing Address - Fax:
Practice Address - Street 1:489 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1419
Practice Address - Country:US
Practice Address - Phone:412-563-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006692224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant