Provider Demographics
NPI:1104490374
Name:RUHL, BETHANY RENAE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:RENAE
Last Name:RUHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:IL
Mailing Address - Zip Code:61410-1804
Mailing Address - Country:US
Mailing Address - Phone:309-341-4473
Mailing Address - Fax:
Practice Address - Street 1:604 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:STRONGHURST
Practice Address - State:IL
Practice Address - Zip Code:61480-5052
Practice Address - Country:US
Practice Address - Phone:309-924-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005572225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology