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General NPI Number Information
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NPI Number | 1568821825
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Entity Type | Individual
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Provider Name | MONICA LYNN BEARD-RAYMOND
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Gender | Female
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 122 BERRY ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4302
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Country | US
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Telephone | 501-765-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 354 MANHATTAN DR UNIT 14
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City | BURLINGTON
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State | VT
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Zip | 05401-4294
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Country | US
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Telephone | 501-765-1313
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 72.0119258
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License Number State | VT
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