Provider Demographics
NPI:1609334937
Name:BEASLEY, AMANDA LEIGH
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LEIGH
Last Name:BEASLEY
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 1:93 WEST ST APT 33
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4861
Mailing Address - Country:US
Mailing Address - Phone:603-834-0463
Mailing Address - Fax:
Practice Address - Street 1:93 WEST ST APT 33
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4861
Practice Address - Country:US
Practice Address - Phone:603-834-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer