Provider Demographics
NPI:1205109576
Name:FITZPATRICK, BETH DAVIS (COTA)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:DAVIS
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRIDES XING
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1012
Mailing Address - Country:US
Mailing Address - Phone:845-496-2830
Mailing Address - Fax:
Practice Address - Street 1:15 PRIDES XING
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1012
Practice Address - Country:US
Practice Address - Phone:845-496-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005546-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant