Provider Demographics
NPI:1811194301
Name:MURRAY, BETHANY HELENE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:HELENE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GATEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4820
Mailing Address - Country:US
Mailing Address - Phone:336-889-5676
Mailing Address - Fax:336-889-5673
Practice Address - Street 1:204 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4820
Practice Address - Country:US
Practice Address - Phone:336-889-5676
Practice Address - Fax:336-889-5673
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10908OtherPARTNERS
NC1384COtherBCBS
NC7301798Medicaid
NC2510989Medicare ID - Type Unspecified