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General NPI Number Information
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NPI Number | 1346874237
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Entity Type | Individual
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Provider Name | LARRY ALAN BEARD COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 311 N SPRING ST
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City | STEELVILLE
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State | MO
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Zip | 65565-5089
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Country | US
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Telephone | 573-775-5815
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Fax | 573-775-4072
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Provider Business Mailing Address
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Address Line | 6 FIG ST APT 11
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City | SULLIVAN
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State | MO
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Zip | 63080-1761
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Country | US
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Telephone | 636-249-3088
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2002012618
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License Number State | MO
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