Provider Demographics
NPI:1124249362
Name:BEEKMAN, AMANDA L (MA, OTRL)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:BEEKMAN
Suffix:
Gender:F
Credentials:MA, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4235
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-4235
Mailing Address - Country:US
Mailing Address - Phone:505-870-6990
Mailing Address - Fax:
Practice Address - Street 1:MUSTANG RD ONE MILE NORTH OF HWY 264
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511-0100
Practice Address - Country:US
Practice Address - Phone:928-871-2822
Practice Address - Fax:928-871-2837
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ921264Medicaid