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1205100906 NPI number — MIA C BEVERIDGE MSOT

NPI Number: 1205100906
Health Care Provider/Practitioner: MIA C BEVERIDGE MSOT

Information about “1205100906” NPI (MIA C BEVERIDGE MSOT) exists in 1205100906 in HTML format HTML  |  1205100906 in plain Text format TXT  |  1205100906 in PDF (Portable Document Format) PDF  |  1205100906 in an XML format XML  formats.

NPI Number : 1205100906 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205100906",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEVERIDGE",
    "FirstName": "MIA",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSOT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 5718",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KALISPELL",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59903-5718",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-756-0134",
    "MailingAddressFaxNumber": "406-300-1612",
    "FirstLinePracticeLocationAddress": "3425 AUSTIN BLUFFS PKWY STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLORADO SPRINGS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80918-5723",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-912-2110",
    "PracticeLocationAddressFaxNumber": "719-400-6413",
    "EnumerationDate": "02/28/2012",
    "LastUpdateDate": "10/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT.0004267",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "OT.0004267",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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