Provider Demographics
NPI:1457081010
Name:SPIVEY, BETHANY JOY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PIPEMAKERS CIR STE 115
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4168
Mailing Address - Country:US
Mailing Address - Phone:912-988-1526
Mailing Address - Fax:912-988-1526
Practice Address - Street 1:110 PIPEMAKERS CIR STE 115
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4168
Practice Address - Country:US
Practice Address - Phone:912-988-1526
Practice Address - Fax:912-988-1526
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist