Provider Demographics
NPI:1588333983
Name:WHEATLEY, BETHANY ALECIA (OTR/L)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ALECIA
Last Name:WHEATLEY
Suffix:
Gender:F
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 1:4810 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-9436
Mailing Address - Country:US
Mailing Address - Phone:859-805-2044
Mailing Address - Fax:
Practice Address - Street 1:530 PERRYVILLE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2012
Practice Address - Country:US
Practice Address - Phone:859-733-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist