Provider Demographics
NPI:1821408352
Name:HARRISON, BETHANY NICOLE (OTA/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NICOLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAGLE STREAM DR APT 37
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5065
Mailing Address - Country:US
Mailing Address - Phone:484-744-5185
Mailing Address - Fax:
Practice Address - Street 1:801 RIDGE PIKE
Practice Address - Street 2:REHAB GYM
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1744
Practice Address - Country:US
Practice Address - Phone:610-825-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOP008738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant