Provider Demographics
NPI:1518223742
Name:BEVERAGE, SARAH BETH (COTA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:BEVERAGE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N ELMER AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319
Mailing Address - Country:US
Mailing Address - Phone:219-924-9126
Mailing Address - Fax:
Practice Address - Street 1:219 N ELMER ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2740
Practice Address - Country:US
Practice Address - Phone:219-924-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000985A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant