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NPI Code Detail

MEDICARE: SANDRA R BEVERLIN MOT, OTR/L

MEDICARE: SANDRA R BEVERLIN MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT.0005359CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740786250
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA R BEVERLIN MOT, OTR/L
Provider Business Mailing Address
First Line : 18406 W WHITE QUEST DR
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84013-9701
Country : US
Telephone Number : 303-840-6374
Fax Number : 303-374-8290
Provider Business Practice Location Address
First Line : 18406 W WHITE QUEST DR
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84013-9701
Country : US
Telephone Number : 217-891-7466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2018
Last Update Date : 04/06/2020

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Directions to “ SANDRA R BEVERLIN MOT, OTR/L” Practice Location

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