Provider Demographics
NPI:1043100191
Name:BE ECCENTRIC LLC
Entity type:Organization
Organization Name:BE ECCENTRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/ L
Authorized Official - Phone:205-213-2084
Mailing Address - Street 1:1704 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-4384
Mailing Address - Country:US
Mailing Address - Phone:205-213-2084
Mailing Address - Fax:
Practice Address - Street 1:1704 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-4384
Practice Address - Country:US
Practice Address - Phone:205-213-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty