Provider Demographics
NPI:1306435839
Name:BEAULIEU, DOTSIE L (COTA)
Entity type:Individual
Prefix:MISS
First Name:DOTSIE
Middle Name:L
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9A REGENT LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6639
Mailing Address - Country:US
Mailing Address - Phone:386-302-2393
Mailing Address - Fax:
Practice Address - Street 1:1050 OCEAN SHORE BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-4126
Practice Address - Country:US
Practice Address - Phone:386-200-5790
Practice Address - Fax:306-224-6110
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist