Healthcare Provider Details

I. General information

NPI: 1265972798
Provider Name (Legal Business Name): BEVERLY NELSON HEMPHILL MS, OTR/L, SWC, HTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 05/05/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 YAJOME ST
NAPA CA
94558-5039
US

IV. Provider business mailing address

2610 YAJOME ST
NAPA CA
94558-5039
US

V. Phone/Fax

Practice location:
  • Phone: 707-339-2147
  • Fax:
Mailing address:
  • Phone: 707-339-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT5297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: