Basic Information
| Provider Information | |||||||||
| NPI: | 1437244035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBINGER | ||||||||
| FirstName: | BEVERLY | ||||||||
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| Credential: | OCCUP THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 N STAFFORD AVE | ||||||||
| Address2: | # 28 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013550359 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 0119004263 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 192576 | 01 | VA | ANTHEM HEALTHKEEP PLUS | OTHER | 4978145 | 05 | VA | MEDICAID |