Provider Demographics
NPI:1801191358
Name:CAUDILL, BEVERLEY ANNETTE
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:ANNETTE
Last Name:CAUDILL
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 1:337 HIGHWAY 3408
Mailing Address - Street 2:
Mailing Address - City:BLACKEY
Mailing Address - State:KY
Mailing Address - Zip Code:41804-9041
Mailing Address - Country:US
Mailing Address - Phone:606-205-6058
Mailing Address - Fax:
Practice Address - Street 1:337 HIGHWAY 3408
Practice Address - Street 2:
Practice Address - City:BLACKEY
Practice Address - State:KY
Practice Address - Zip Code:41804-9041
Practice Address - Country:US
Practice Address - Phone:606-205-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200112990222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist