Kristen Beard, COTA/L

Key facts

NPI

1962986158

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapy Assistant 224Z00000X

License

TA32507 (MS)

Practice address

1301A Harrison Ave
McComb, MS 39648-2829

Phone

(601) 250-5455

Fax

(601) 250-5453

NPI assigned

Sep 24, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Rehab Associates Physical Therapist · McComb, MS · NPI 1801192307
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 24, 2018.

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1962986158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301A HARRISON AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482829",
            "telephone_number": "601-250-5455",
            "fax_number": "601-250-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301A HARRISON AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482829",
            "telephone_number": "601-250-5455",
            "fax_number": "601-250-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEARD",
        "first_name": "KRISTEN",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MS",
            "license": "TA32507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in McComb, MS · Occupational Therapy Assistant in Mississippi