Provider Demographics
NPI:1770849226
Name:BEAL, GRACE LYNNETTE (OTR)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LYNNETTE
Last Name:BEAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-0009
Mailing Address - Country:US
Mailing Address - Phone:281-354-3383
Mailing Address - Fax:281-354-6750
Practice Address - Street 1:23110 FORD RD STE A
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5416
Practice Address - Country:US
Practice Address - Phone:281-354-3383
Practice Address - Fax:281-354-6750
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist