Provider Demographics
NPI:1851080048
Name:BEYERLY, STELLA T (COTA/L)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:T
Last Name:BEYERLY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:T
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:15752 PAIUTE CIR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6092
Mailing Address - Country:US
Mailing Address - Phone:571-205-9958
Mailing Address - Fax:
Practice Address - Street 1:110 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6713
Practice Address - Country:US
Practice Address - Phone:719-475-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000852224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant