Provider Demographics
NPI:1083051619
Name:KEENER, BETHANY ALICE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ALICE
Last Name:KEENER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2613
Mailing Address - Country:US
Mailing Address - Phone:201-819-5569
Mailing Address - Fax:
Practice Address - Street 1:2780 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1911
Practice Address - Country:US
Practice Address - Phone:510-536-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist