Provider Demographics
NPI:1144284324
Name:ANDERSEN, BEVERLY (OTRL,CHT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:OTRL,CHT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:DE KRUYF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 SW 160TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3003
Mailing Address - Country:US
Mailing Address - Phone:206-244-4263
Mailing Address - Fax:206-244-8703
Practice Address - Street 1:275 SW 160TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-244-4263
Practice Address - Fax:206-244-8703
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001672225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAN4985OtherREGENCE
WA8920943OtherCRIME VICTUMS
WAA005OtherTRICARE
WA0046225OtherDEPT. OF LABOR&INDUSTRIES
WA8339822Medicaid
WA8339822Medicaid