Provider Demographics
NPI:1952965303
Name:MCMILLEN, BETHANY MARIE (OT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:230 SUMMIT RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0907
Mailing Address - Country:US
Mailing Address - Phone:636-699-5548
Mailing Address - Fax:
Practice Address - Street 1:1310 NW DEANE ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3705
Practice Address - Country:US
Practice Address - Phone:509-332-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60920416225X00000X
MO2018030897225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist