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NPI Code Detail

MEDICARE: TIMOTHY BEAULIEU OTR

MEDICARE: TIMOTHY BEAULIEU OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT002148GA

General Provider Information

NPI Number : 1407847411
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY BEAULIEU OTR
Provider Business Mailing Address
First Line : 5209 WINDMILL CT
Second Line :
City : EVANS
State : GA
Zip : 30809-6667
Country : US
Telephone Number : 706-651-1146
Fax Number :
Provider Business Practice Location Address
First Line : 300 HOSPITAL DR.
Second Line : DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER
City : FT. GORDON
State : GA
Zip : 30905
Country : US
Telephone Number : 706-787-9042
Fax Number : 706-787-0105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 09/24/2013

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Directions to “ TIMOTHY BEAULIEU OTR” Practice Location

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