Provider Demographics
NPI:1972726255
Name:BEANE, VICKI LYNN (OTR L)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:BEANE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:738 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1008
Mailing Address - Country:US
Mailing Address - Phone:909-880-1655
Mailing Address - Fax:
Practice Address - Street 1:9161 SIERRA AVE
Practice Address - Street 2:SUIET 111
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4729
Practice Address - Country:US
Practice Address - Phone:909-427-4073
Practice Address - Fax:909-427-4736
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics