Provider Demographics
NPI:1922204114
Name:BEARD, JOHN MASON (OT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MASON
Last Name:BEARD
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ARCADIA PARK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4579
Mailing Address - Country:US
Mailing Address - Phone:678-493-6836
Mailing Address - Fax:
Practice Address - Street 1:121 ARCADIA PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4579
Practice Address - Country:US
Practice Address - Phone:678-493-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT002325OtherSTATE OT LICENSE