Provider Demographics
NPI:1790786275
Name:JARVIS, BEATRICE (OTRL)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6000
Mailing Address - Country:US
Mailing Address - Phone:706-378-9044
Mailing Address - Fax:706-378-9046
Practice Address - Street 1:304 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6000
Practice Address - Country:US
Practice Address - Phone:706-378-9044
Practice Address - Fax:706-378-9046
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340946Medicaid
GA10047134Medicaid
GA52703833OtherBLUE CROSS BLUE SHIELD
GA52703833OtherBLUE CROSS BLUE SHIELD