Basic Information
| Provider Information | |||||||||
| NPI: | 1760076426 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KNIGHT | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2280 E STATE ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | PAXTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609574100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177812031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 E RAYMOND RD | ||||||||
| Address2: | |||||||||
| City: | WATSEKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609709730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154325476 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2021 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057005472 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.