Provider Demographics
NPI:1104904580
Name:HOGAN, BETHANY KAYE (OTR L)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:KAYE
Last Name:HOGAN
Suffix:
Gender:
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 BURRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9676
Mailing Address - Country:US
Mailing Address - Phone:330-659-3016
Mailing Address - Fax:
Practice Address - Street 1:3480 BURRWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9676
Practice Address - Country:US
Practice Address - Phone:330-659-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist