Provider Demographics
NPI:1538769286
Name:KRALL, BEVERLY (OTR/L)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:KRALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 GARDNER ST E
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2708
Mailing Address - Country:US
Mailing Address - Phone:586-344-0454
Mailing Address - Fax:
Practice Address - Street 1:22701 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2943
Practice Address - Country:US
Practice Address - Phone:248-733-4325
Practice Address - Fax:248-268-7979
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist