Provider Demographics
NPI:1760076426
Name:KNIGHT, BETHANY M (COTA/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 E STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-4100
Mailing Address - Country:US
Mailing Address - Phone:217-781-2031
Mailing Address - Fax:
Practice Address - Street 1:715 E RAYMOND RD
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-9730
Practice Address - Country:US
Practice Address - Phone:815-432-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant