Wallace, Beverly

Wallace, Beverly is an individual health care provider with primary practice located at 3911 Golf Park Loop Suite #105, Bradenton FL 34203-3453. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Wallace, Beverly can be contacted via phone (941) 756-1003.

Contact Information

Primary practice address
3911 Golf Park Loop Suite #105 Bradenton FL 34203-3453
Phone: (941) 756-1003
Fax: (941) 756-6003
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OT9730 Florida

Profile Details

NPI number 1174595367
LBN Legal business name Wallace, Beverly
Credentials OTR/L
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174595367 NPPES
Florida Other Y902F BCBS

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