Provider Demographics
NPI:1932286291
Name:MASON, BETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MASON
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 1:106 COMER ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-8026
Mailing Address - Country:US
Mailing Address - Phone:256-247-1512
Mailing Address - Fax:
Practice Address - Street 1:993 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4432
Practice Address - Country:US
Practice Address - Phone:931-363-3572
Practice Address - Fax:931-363-5001
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN403784224Z00000X
AL2192224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant