Provider Demographics
NPI:1598323404
Name:BEASLEY, HANNAH MADISON (COTA/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MADISON
Last Name:BEASLEY
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 1:716 WOOD BROTHERS DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:716 WOOD BROTHERS DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1406
Practice Address - Country:US
Practice Address - Phone:540-230-1582
Practice Address - Fax:276-694-4481
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131-002719224Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst