Healthcare Provider Details

I. General information

NPI: 1740786250
Provider Name (Legal Business Name): SANDRA R BEVERLIN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA R BEVERLIN MOT, OTR/L

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 6TH ST STE 301B
CASTLE ROCK CO
80104-1731
US

IV. Provider business mailing address

3674 CERF WAY
CASTLE ROCK CO
80109-3874
US

V. Phone/Fax

Practice location:
  • Phone: 217-891-7466
  • Fax:
Mailing address:
  • Phone: 303-720-6174
  • Fax: 303-720-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0005359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: