Beverly Wallace, OTR/L
Occupational Therapist in Bradenton, FL. Individual provider (NPI-1).
NPI number1174595367
StatusActive
Last updated in NPPESJul 13, 2026
Details
- NPI
- 1174595367
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Beverly Wallace
- Credential
- OTR/L
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 2, 2006
- Last updated
- Jul 13, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | OT9730 | FL | Yes |
Practice location
3911 Golf Park LoopSuite #105
Bradenton, FL 34203-3453
Phone 941-756-1003 · Fax 941-756-6003
Mailing address
6477 Indigo Bunting PlBradenton, FL 34202-8246
Phone 941-756-1003 · Fax 941-756-6003
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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