Provider Demographics
NPI:1649586512
Name:BEEVER, KRISTINE B
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:B
Last Name:BEEVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:B
Other - Last Name:SELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4470 BLOODS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9413
Mailing Address - Country:US
Mailing Address - Phone:815-547-6978
Mailing Address - Fax:
Practice Address - Street 1:4470 BLOODS POINT RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9413
Practice Address - Country:US
Practice Address - Phone:815-547-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist