Provider Demographics
NPI:1386454882
Name:SHOEMAKER, BETHANY (OTR, MOT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1741
Mailing Address - Country:US
Mailing Address - Phone:806-353-3596
Mailing Address - Fax:806-353-4927
Practice Address - Street 1:1250 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1741
Practice Address - Country:US
Practice Address - Phone:806-353-3596
Practice Address - Fax:806-353-4927
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist