Provider Demographics
NPI:1104217041
Name:WRIGHT, BETHANY CAROLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:CAROLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5545
Mailing Address - Country:US
Mailing Address - Phone:920-216-1316
Mailing Address - Fax:
Practice Address - Street 1:4810 BARBICAN AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4189
Practice Address - Country:US
Practice Address - Phone:715-393-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5079224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant