Provider Demographics
NPI:1346806965
Name:BERTRAND, BETHANY KAY (COTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:BERTRAND
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 1:2038 DIAL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3508
Mailing Address - Country:US
Mailing Address - Phone:217-801-7199
Mailing Address - Fax:
Practice Address - Street 1:19130 SUNNY ACRES RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-7306
Practice Address - Country:US
Practice Address - Phone:217-632-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant