Provider Demographics
NPI:1942542410
Name:BEAVER, HEATHER L (OT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9574
Mailing Address - Country:US
Mailing Address - Phone:574-315-7604
Mailing Address - Fax:574-675-9344
Practice Address - Street 1:1415 LINCOLNWAY W
Practice Address - Street 2:SUITE M
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2062
Practice Address - Country:US
Practice Address - Phone:574-675-7767
Practice Address - Fax:574-675-9344
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003315A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist