Healthcare Provider Details

I. General information

NPI: 1427976208
Provider Name (Legal Business Name): BETHANY COOK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 GA HIGHWAY 247 S
KATHLEEN GA
31047-2349
US

IV. Provider business mailing address

215 GLENEAGLE DR
BYRON GA
31008-3810
US

V. Phone/Fax

Practice location:
  • Phone: 478-732-1315
  • Fax:
Mailing address:
  • Phone: 478-732-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: