Provider Demographics
NPI:1487708269
Name:SELLERS, BETH MAE (COTAL)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MAE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71370 JAMES MERRITT LANE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-968-1080
Mailing Address - Fax:
Practice Address - Street 1:71370 JAMES MERRITT LANE
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-968-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051264224Z00000X
WVC1427224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant