Provider Demographics
NPI:1134789142
Name:DAISY, BETH ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:DAISY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:23 TIRRELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5209
Mailing Address - Country:US
Mailing Address - Phone:801-828-7184
Mailing Address - Fax:
Practice Address - Street 1:25 WALKER ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4592
Practice Address - Country:US
Practice Address - Phone:603-224-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist