Provider Demographics
NPI:1003312695
Name:SKINNER, BETHANY CRYSTAL (MAOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CRYSTAL
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MAOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 FOX MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9043
Mailing Address - Country:US
Mailing Address - Phone:612-401-2142
Mailing Address - Fax:
Practice Address - Street 1:1801 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1934
Practice Address - Country:US
Practice Address - Phone:763-682-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist