MEDICARE: MRS. BETHANIE SKAGGS-MANLEY MS, OT/L, CBIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XN1300X	Neurorehabilitation Occupational Therapist	R3680	KY

General Provider Information

NPI Number	:	1083079032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANIE SKAGGS-MANLEY MS, OT/L, CBIS

Provider Business Mailing Address
First Line	:	103 WINDSOR PATH
Second Line	:	4
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9610
Country	:	US
Telephone Number	:	502-863-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 WINDSOR PATH
Second Line	:	4
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9610
Country	:	US
Telephone Number	:	502-863-3870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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