Basic Information
| Provider Information | |||||||||
| NPI: | 1639420284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMPTON-GREEN | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12116 TOWNLINE RD | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484391602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107309463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483811517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486851460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2012 | ||||||||
| LastUpdateDate: | 09/23/2012 | ||||||||
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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 | 224Z00000X | 5202007027 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.