MEDICARE: MRS. BETHANY NAUGHTON OTR-L

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	225X00000X	Occupational Therapist	004767	MO

General Provider Information

NPI Number	:	1265577852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY NAUGHTON OTR-L

Provider Business Mailing Address
First Line	:	16881 S BUD WYMAN LN
Second Line	:
City	:	HARTSBURG
State	:	MO
Zip	:	65039-9570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 SOUTHWEST BLVD
Second Line	:	CAPTIAL REGION HOME HEALTH
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65102-1128
Country	:	US
Telephone Number	:	573-632-5752
Fax Number	:	573-632-5868

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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