Provider Demographics
NPI:1467502500
Name:STEVENSON, BETHANY KAY (OTRL)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:KAY
Other - Last Name:RINGGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2959 SHARPSBURG MCCULLUM RD
Mailing Address - Street 2:BLDG C STE C
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2297
Mailing Address - Country:US
Mailing Address - Phone:770-683-0250
Mailing Address - Fax:770-683-4250
Practice Address - Street 1:116 OAK PARK SQ
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5511
Practice Address - Country:US
Practice Address - Phone:770-683-0250
Practice Address - Fax:770-683-4250
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist