Provider Demographics
NPI:1821289281
Name:BUMGARNER, BEVERLY KIM HUFFMAN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:KIM HUFFMAN
Last Name:BUMGARNER
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 1:4135 22ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7449
Mailing Address - Country:US
Mailing Address - Phone:828-302-4219
Mailing Address - Fax:
Practice Address - Street 1:16405 NORTHCROSS DR
Practice Address - Street 2:SUITE G2
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5091
Practice Address - Country:US
Practice Address - Phone:704-897-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4192224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant