Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0001580 | CO |
NPI | 1225513641 |
---|---|
Provider Name | Kristin Alyce Beveridge |
First Address | Lakewood, CO 80226-2908 |
Second Address | Lakewood, CO 80226-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2018 |
Last Update Date | 02/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001580 | STATE LICENSE (01) | CO |