Provider Demographics
NPI:1679638688
Name:BEAVER, JILL (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 WRIGHTS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9742
Mailing Address - Country:US
Mailing Address - Phone:270-668-9125
Mailing Address - Fax:
Practice Address - Street 1:1563 WRIGHTS LANDING RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9742
Practice Address - Country:US
Practice Address - Phone:270-668-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45118379EPSDTMedicaid
KY33000035SCLMedicaid
KY11903135ICFMedicaid
KY45118379EPSDTMedicaid