Provider Demographics
NPI:1679032932
Name:PHILLIPS, BEVERLY VANDEVENDER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:VANDEVENDER
Last Name:PHILLIPS
Suffix:
Gender:F
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 1:7228 BURT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3234
Mailing Address - Country:US
Mailing Address - Phone:402-291-3258
Mailing Address - Fax:
Practice Address - Street 1:7228 BURT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3234
Practice Address - Country:US
Practice Address - Phone:402-306-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01422225XE0001X
NE646225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification