Provider Demographics
NPI:1013522648
Name:WHEELER, BEVERLY (OT)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 ROSEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2069
Mailing Address - Country:US
Mailing Address - Phone:443-846-7327
Mailing Address - Fax:
Practice Address - Street 1:14235 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5261
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1013522648Medicaid