Healthcare Provider Details

I. General information

NPI: 1235578147
Provider Name (Legal Business Name): GAIL K BEAVER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE BEAVER OTR

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 NEVADA AVE
LAS CRUCES NM
88001-3902
US

IV. Provider business mailing address

1800 COPPER LOOP
LAS CRUCES NM
88005-8139
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-4900
  • Fax: 575-523-1756
Mailing address:
  • Phone: 575-524-2575
  • Fax: 575-523-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2712
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: