Provider Demographics
NPI:1477119444
Name:SWARTZ, BETHANY (OTRL)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 KIRKLAND CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4974
Mailing Address - Country:US
Mailing Address - Phone:269-345-0669
Mailing Address - Fax:269-342-7840
Practice Address - Street 1:7920 KIRKLAND CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4974
Practice Address - Country:US
Practice Address - Phone:269-345-0669
Practice Address - Fax:269-342-7840
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010537225X00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation