Provider Demographics
NPI:1629549795
Name:SCHULT, BETHANY CLARE (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:CLARE
Last Name:SCHULT
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:CLARE
Other - Last Name:BUROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:12871 ISLE ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8671
Mailing Address - Country:US
Mailing Address - Phone:517-897-5152
Mailing Address - Fax:
Practice Address - Street 1:12871 ISLE ROYALE DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8671
Practice Address - Country:US
Practice Address - Phone:517-897-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588642110Medicaid