Provider Demographics
NPI:1699961821
Name:BEAUCHAMP, LUCY (MBA, MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MBA, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DORIS AVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3413
Mailing Address - Country:US
Mailing Address - Phone:270-579-1784
Mailing Address - Fax:
Practice Address - Street 1:1505 S DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1480
Practice Address - Country:US
Practice Address - Phone:270-579-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist