Provider Demographics
NPI:1750956777
Name:THOMPSON, BETHANY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6349
Mailing Address - Country:US
Mailing Address - Phone:502-429-8640
Mailing Address - Fax:502-426-2283
Practice Address - Street 1:4912 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6349
Practice Address - Country:US
Practice Address - Phone:502-429-8640
Practice Address - Fax:502-426-2283
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist