Provider Demographics
NPI:1649419136
Name:PORTER, BETHANY MORGAN (COTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MORGAN
Last Name:PORTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 KEYSTONE XING
Mailing Address - Street 2:SUITE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7670
Mailing Address - Country:US
Mailing Address - Phone:317-218-0654
Mailing Address - Fax:317-218-0684
Practice Address - Street 1:8900 KEYSTONE XING
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7670
Practice Address - Country:US
Practice Address - Phone:317-218-0654
Practice Address - Fax:317-218-0684
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001501A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant