Provider Demographics
NPI:1184791972
Name:AUSMAN, BETH MARIE (MS, OTRL)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MARIE
Last Name:AUSMAN
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:MARIE
Other - Last Name:LERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6123 W 140TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1937
Mailing Address - Country:US
Mailing Address - Phone:952-226-5154
Mailing Address - Fax:612-728-5354
Practice Address - Street 1:3333 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3325
Practice Address - Country:US
Practice Address - Phone:612-728-5396
Practice Address - Fax:612-728-5354
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103218225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082H6AUOtherBLUE CROSS