Individual
RENECER BEACHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2002 BAYVIEW DR, FORT WAYNE, IN 46815-4221
(260) 424-2537
Mailing address
2002 BAYVIEW DR, FORT WAYNE, IN 46815-4221
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001126A
IN
Other
Enumeration date
09/18/2008
Last updated
09/18/2008
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