Healthcare Provider Details

I. General information

NPI: 1760928634
Provider Name (Legal Business Name): BETHANY BECKNER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 VETERANS DR
HANSON KY
42413-9401
US

IV. Provider business mailing address

200 SHORT 70 RD
PRINCETON KY
42445-5437
US

V. Phone/Fax

Practice location:
  • Phone: 270-322-3528
  • Fax:
Mailing address:
  • Phone: 270-635-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number135108
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: