Beverly Wallace, OTR/L
Individual provider Active NPI Occupational Therapist · Bradenton, FL
NPI 1174595367 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1174595367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT9730 (FL)
- Practice address
- 3911 Golf Park Loop
Suite #105
Bradenton, FL 34203-3453 - Phone
- (941) 756-1003
- Fax
- (941) 756-6003
- NPI assigned
- Feb 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Active Living Rehabilitation Inc | Occupational Therapist | Current |
Accepting new patients |
| Children'S Therapy Associates, Inc | Occupational Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT9730 | FL | Yes |
Addresses
Primary practice location
3911 Golf Park Loop
Suite #105
Bradenton, FL 34203-3453
Mailing address
6477 Indigo Bunting PL
Bradenton, FL 34202-8246
Phone (941) 756-1003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y902F | Other | FL | BCBS |
Other providers in Bradenton, FL
- Maria Breanne Lowery Walker
- Meadow L. Walker
- Nelsie Eneida Walker
- Shanaria Walker
- Makiesha Wallace-Watson
- Chloe Wallace
- Michael Anthony Wallace
- Stacie L Wallace
- Walsh Family Medicine LLC
- Douglas A Walsh Jr.
All providers in Bradenton, FL · Occupational Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.