Basic Information
| Provider Information | |||||||||
| NPI: | 1366721730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEECHER | ||||||||
| FirstName: | CORRIE | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 23RD AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342054524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122016247 | ||||||||
| FaxNumber: | 9417298322 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 6TH ST S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277674257 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT14723 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 003964800 | 05 | FL | MEDICAID |