Provider Demographics
NPI:1255588844
Name:BECKHAM, IRNA LESHAYNE (OTR/L)
Entity type:Individual
Prefix:
First Name:IRNA
Middle Name:LESHAYNE
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:IRNA
Other - Middle Name:L
Other - Last Name:BECKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6520 SUNSCOPE DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8690
Mailing Address - Country:US
Mailing Address - Phone:228-875-1177
Mailing Address - Fax:228-875-1177
Practice Address - Street 1:6520 SUNSCOPE DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-8690
Practice Address - Country:US
Practice Address - Phone:228-875-1177
Practice Address - Fax:228-875-1177
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890023420Medicaid