Provider Demographics
NPI:1023004199
Name:MICKE, BETH M (OT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:MICKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:ZARBOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2446
Mailing Address - Country:US
Mailing Address - Phone:605-782-2300
Mailing Address - Fax:605-782-2301
Practice Address - Street 1:2501 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2446
Practice Address - Country:US
Practice Address - Phone:605-782-2300
Practice Address - Fax:605-782-2301
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD31685OtherSIOUX VALLEY HEALTH PLANS
SD4996085OtherBLUE CROSS BLUE SHIELD SD
SD64-04068OtherMEDICA
SD64-04070OtherMEDICA
SD101K4MIOtherBLUE CROSS BLUE SHIELD MN
SD64-05328OtherMEDICA
SD5834110Medicaid
SD5834113Medicaid
SD4996086OtherBLUE CROSS BLUE SHIELD SD
SD4996087OtherBLUE CROSS BLUE SHIELD SD
SD64-04069OtherMEDICA
SD4994834OtherBLUE CROSS BLUE SHIELD SD
SD5834112Medicaid
SD1907880OtherARAZ
SD5834114Medicaid