Provider Demographics
NPI:1780362442
Name:BECKMANN, BREANNA VIRGINIA (OTR, OTD)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:VIRGINIA
Last Name:BECKMANN
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13816 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-5721
Mailing Address - Country:US
Mailing Address - Phone:618-975-7780
Mailing Address - Fax:
Practice Address - Street 1:2532 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3131
Practice Address - Country:US
Practice Address - Phone:314-845-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023027772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist