Provider Demographics
NPI:1578736179
Name:GARDNER, BETHANY S (OTD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:S
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:1 LONE STAR PASS
Mailing Address - Street 2:BLDG 46
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78264-3638
Mailing Address - Country:US
Mailing Address - Phone:210-263-5720
Mailing Address - Fax:210-263-5721
Practice Address - Street 1:1 LONE STAR PASS
Practice Address - Street 2:BLDG 46
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78264-3638
Practice Address - Country:US
Practice Address - Phone:210-263-5720
Practice Address - Fax:210-263-5721
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist