Provider Demographics
NPI:1194952341
Name:BROWN, BEVERLY KAY (OTR)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 COUNTY ROAD 7340
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8301
Mailing Address - Country:US
Mailing Address - Phone:806-745-3609
Mailing Address - Fax:
Practice Address - Street 1:4302 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1304
Practice Address - Country:US
Practice Address - Phone:806-749-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist