Provider Demographics
NPI:1790164051
Name:LUKE, BETHANY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:LUKE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 JONES FRANKLIN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3376
Mailing Address - Country:US
Mailing Address - Phone:919-852-0702
Mailing Address - Fax:919-852-0742
Practice Address - Street 1:1611 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3376
Practice Address - Country:US
Practice Address - Phone:919-852-0702
Practice Address - Fax:919-852-0742
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9697225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist