Provider Demographics
NPI:1316287873
Name:FLEENOR, BETH JOELLEN (OTR)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:JOELLEN
Last Name:FLEENOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 S ALSUP RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7249
Mailing Address - Country:US
Mailing Address - Phone:812-752-1521
Mailing Address - Fax:
Practice Address - Street 1:2354 S ALSUP RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7249
Practice Address - Country:US
Practice Address - Phone:812-752-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003343A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist