Provider Demographics
NPI:1790187946
Name:MITCHELL, BETHANY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MITCHELL
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 1:3826 N FARM ROAD 165
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-8037
Mailing Address - Country:US
Mailing Address - Phone:417-224-2870
Mailing Address - Fax:
Practice Address - Street 1:1545 E PYTHIAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2139
Practice Address - Country:US
Practice Address - Phone:417-829-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008020654225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist