Provider Demographics
NPI:1609273788
Name:BEYER, EMILY
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 MCKINNEY AVE APT 712
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2374
Mailing Address - Country:US
Mailing Address - Phone:817-201-1559
Mailing Address - Fax:
Practice Address - Street 1:12810 HILLCREST RD
Practice Address - Street 2:B100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1525
Practice Address - Country:US
Practice Address - Phone:972-404-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115218225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics