Provider Demographics
NPI:1427826916
Name:WOOD, BETHANY MARIE (MOT, OTR)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 3RD AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2669
Mailing Address - Country:US
Mailing Address - Phone:217-778-1438
Mailing Address - Fax:
Practice Address - Street 1:18406 W WHITE QUEST DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84013-9701
Practice Address - Country:US
Practice Address - Phone:801-335-4699
Practice Address - Fax:801-335-7031
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist