Provider Demographics
NPI:1871357160
Name:BEARD, AUSTIN DAVID
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DAVID
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 RAUTH ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-2046
Mailing Address - Country:US
Mailing Address - Phone:567-356-6084
Mailing Address - Fax:
Practice Address - Street 1:308 RAUTH ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-2046
Practice Address - Country:US
Practice Address - Phone:567-356-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services