Provider Demographics
NPI:1598889206
Name:BEVIL, TINA
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:BEVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 LYNN OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ASSOCIATION DR
Practice Address - Street 2:SUITE 209
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1272
Practice Address - Country:US
Practice Address - Phone:304-342-7049
Practice Address - Fax:304-342-7206
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist