Provider Demographics
NPI:1508967720
Name:BETHELL, ASHLEY JO (MSE, ATC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:JO
Last Name:BETHELL
Suffix:
Gender:F
Credentials:MSE, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HARRISON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6116
Mailing Address - Country:US
Mailing Address - Phone:217-653-9099
Mailing Address - Fax:
Practice Address - Street 1:1118 HAMPSHIRE ST.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-1851
Practice Address - Country:US
Practice Address - Phone:217-222-6550
Practice Address - Fax:217-231-2079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-005022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer