Provider Demographics
NPI:1861682809
Name:WARNER, BETHANY DAWN (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:DAWN
Last Name:WARNER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-9571
Mailing Address - Country:US
Mailing Address - Phone:817-476-2480
Mailing Address - Fax:
Practice Address - Street 1:4201 BRIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9571
Practice Address - Country:US
Practice Address - Phone:817-476-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014302-1225X00000X
TX120550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist