Provider Demographics
NPI:1811951270
Name:BEALS, KATHLEEN M (OTR)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BEALS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 AUTUMNWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4464
Mailing Address - Country:US
Mailing Address - Phone:864-228-2646
Mailing Address - Fax:
Practice Address - Street 1:219 GERALD DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4111
Practice Address - Country:US
Practice Address - Phone:864-567-1129
Practice Address - Fax:864-335-8514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0998Medicaid