Provider Demographics
NPI:1790358026
Name:RODGERS, BETHANY (COTA/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RODGERS
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 1:50 GREEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2976
Mailing Address - Country:US
Mailing Address - Phone:716-713-5282
Mailing Address - Fax:
Practice Address - Street 1:141 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1359
Practice Address - Country:US
Practice Address - Phone:716-687-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant