Provider Demographics
NPI:1174619118
Name:STEWART, BETHANY ANN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANN
Last Name:STEWART
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 1:206 LULA AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1513
Mailing Address - Country:US
Mailing Address - Phone:573-986-1521
Mailing Address - Fax:
Practice Address - Street 1:205 E MORLEY
Practice Address - Street 2:
Practice Address - City:MARQUAND
Practice Address - State:MO
Practice Address - Zip Code:63655-9161
Practice Address - Country:US
Practice Address - Phone:573-986-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003014142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant