Provider Demographics
NPI:1639807118
Name:WILLIAMS, BETHANY R (CO, CFM)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CO, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 OFFICE PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7516
Mailing Address - Country:US
Mailing Address - Phone:501-508-2227
Mailing Address - Fax:
Practice Address - Street 1:611 OFFICE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7516
Practice Address - Country:US
Practice Address - Phone:501-508-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00176222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist