Provider Demographics
NPI:1942591003
Name:BEACH, LAURA LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:BEACH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 STATE HIGHWAY 21 E
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-4611
Mailing Address - Country:US
Mailing Address - Phone:979-567-8408
Mailing Address - Fax:
Practice Address - Street 1:1022 STATE HIGHWAY 21 E
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-4611
Practice Address - Country:US
Practice Address - Phone:979-567-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211157224Z00000X
WI4730-027224Z00000X
MO2010026802224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant