Provider Demographics
NPI:1255560751
Name:DAVIDSON, BETHANY ANNETTE (OTR)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANNETTE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:ANNETTE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4716
Mailing Address - Country:US
Mailing Address - Phone:256-235-5688
Mailing Address - Fax:256-235-5590
Practice Address - Street 1:400 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4716
Practice Address - Country:US
Practice Address - Phone:256-235-5688
Practice Address - Fax:256-235-5590
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist