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General NPI Number Information
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NPI Number | 1023497278
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Entity Type | Individual
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Provider Name | BETHANN FABUGAIS OTR
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 1200 ROOSEVELT PL UNIT A
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City | VALPARAISO
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State | IN
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Zip | 46383-3707
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Country | US
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Telephone | 219-548-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 2507 ESTERO PKWY
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City | VALPARAISO
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State | IN
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Zip | 46383-3877
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Country | US
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Telephone | 219-776-1008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31003938A
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License Number State | IN
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