Provider Demographics
NPI:1831141423
Name:BEAVIN, KAREN R (OTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
Last Name:BEAVIN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:300 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1528
Practice Address - Country:US
Practice Address - Phone:219-836-0027
Practice Address - Fax:219-836-0067
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000015A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01228315OtherMEDICARE RAILROAD
IN487210007Medicare PIN
INP01228315OtherMEDICARE RAILROAD