Provider Demographics
NPI:1982291613
Name:ROMAINE, BETHANI ROSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BETHANI
Middle Name:ROSE
Last Name:ROMAINE
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 1:316 GLEN AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5127
Mailing Address - Country:US
Mailing Address - Phone:302-344-1035
Mailing Address - Fax:
Practice Address - Street 1:316 GLEN AVE APT 303
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5127
Practice Address - Country:US
Practice Address - Phone:302-344-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant