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General NPI Number Information
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NPI Number | 1205100906
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Entity Type | Individual
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Provider Name | MIA C BEVERIDGE MSOT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 3425 AUSTIN BLUFFS PKWY STE 105
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5723
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Country | US
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Telephone | 719-912-2110
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Fax | 719-400-6413
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Provider Business Mailing Address
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Address Line | PO BOX 5718
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City | KALISPELL
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State | MT
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Zip | 59903-5718
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Country | US
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Telephone | 406-756-0134
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Fax | 406-300-1612
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT.0004267
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0004267
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License Number State | CO
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