Provider Demographics
NPI:1841412392
Name:BEACH, BETH (MS, OTR, ATP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:MS, OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHILDREN'S LANE
Mailing Address - Street 2:5TH FLOOR, WHEELCHAIR CLINIC
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-668-9685
Mailing Address - Fax:757-668-9111
Practice Address - Street 1:601 CHILDREN'S LANE
Practice Address - Street 2:5TH FLOOR, WHEELCHAIR CLINIC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-668-9685
Practice Address - Fax:757-668-9111
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000181225XP0200X
NC1294225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics