Provider Demographics
NPI:1013442912
Name:BECK, JAMES JR (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BECK
Suffix:JR
Gender:M
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 1:4227 N 27TH AVE
Mailing Address - Street 2:APT. 2035
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4227 N 27TH AVE
Practice Address - Street 2:APT. 2035
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5904
Practice Address - Country:US
Practice Address - Phone:510-789-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6949224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant