Provider Demographics
NPI:1568553246
Name:DEAN, MARY BETH
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:DEAN
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 1:906 LILY CREEK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2807
Mailing Address - Country:US
Mailing Address - Phone:502-409-4327
Mailing Address - Fax:502-805-0457
Practice Address - Street 1:906 LILY CREEK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2807
Practice Address - Country:US
Practice Address - Phone:502-409-4327
Practice Address - Fax:502-805-0457
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist