Provider Demographics
NPI:1588820757
Name:PIKE, BETHANY JUSCEN (CMT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JUSCEN
Last Name:PIKE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0642
Mailing Address - Country:US
Mailing Address - Phone:802-999-6578
Mailing Address - Fax:
Practice Address - Street 1:1881 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6006
Practice Address - Country:US
Practice Address - Phone:802-999-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist