Provider Demographics
NPI:1427563204
Name:ELKINGTON, BETHANY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ELKINGTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E 55TH ST # 15363
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-6902
Mailing Address - Country:US
Mailing Address - Phone:773-270-3169
Mailing Address - Fax:
Practice Address - Street 1:5764 SOUTH ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:773-270-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012149225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist