| Doctor Name: | MS. ELISABETH BEAVAN |
| NPI Number: | 1346331956 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OTR |
| License Number: | 002548-1 |
| Business Practice Address: | 600 Tuckers Ln Southold, NY - 119713044 |
| Business Phone Number: | 6317652283 |
| Business Fax Number: | 6317656879 |
| Mailing Address: | 600 Tuckers Ln, SOUTHOLD |
| State: | NY |
| Postal Code: | 119713044 |
| Phone Number: | 6317652283 |
| Fax Number: | 6317656879 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 01/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 002548-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |