Provider Demographics
NPI:1881881779
Name:SEREDICK, BEVERLY L (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:L
Last Name:SEREDICK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 TWIN CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1066
Mailing Address - Country:US
Mailing Address - Phone:850-729-3325
Mailing Address - Fax:850-729-2052
Practice Address - Street 1:554 TWIN CITIES BLVD
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1066
Practice Address - Country:US
Practice Address - Phone:850-729-3325
Practice Address - Fax:850-729-2052
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005828225XH1200X
FL17913225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17913OtherOT LICENSE