Healthcare Provider Details

I. General information

NPI: 1245377738
Provider Name (Legal Business Name): HILLARY M. BETHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 SW 97TH AVE 2ND FLOOR
PALMETTO BAY FL
33157-5636
US

IV. Provider business mailing address

17615 SW 97TH AVE 2ND FLOOR
PALMETTO BAY FL
33157-5636
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-2679
  • Fax: 786-268-1748
Mailing address:
  • Phone: 786-624-2679
  • Fax: 786-268-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: