Provider Demographics
NPI:1861958027
Name:NORTH, BETHANY C (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:C
Last Name:NORTH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRACE HAVEN COURT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37342
Mailing Address - Country:US
Mailing Address - Phone:901-237-4937
Mailing Address - Fax:
Practice Address - Street 1:928 OLD SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-6805
Practice Address - Country:US
Practice Address - Phone:931-473-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2002224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant