Provider Demographics
NPI:1790349231
Name:DEPALO MILOS, BETHANY FAITH
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:FAITH
Last Name:DEPALO MILOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TURKEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-8163
Mailing Address - Country:US
Mailing Address - Phone:732-829-0659
Mailing Address - Fax:
Practice Address - Street 1:511 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6126
Practice Address - Country:US
Practice Address - Phone:718-965-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty