Basic Information
| Provider Information | |||||||||
| NPI: | 1467502500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | O.T.R.L. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RINGGOLD | ||||||||
| OtherFirstName: | BETHANY | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2959 SHARPSBURG MCCULLUM RD | ||||||||
| Address2: | BLDG C STE C | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706830250 | ||||||||
| FaxNumber: | 7706834250 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 OAK PARK SQ | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302655511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706830250 | ||||||||
| FaxNumber: | 7706834250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT004467 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.