MEDICARE: MRS. BETHANY LEANN SMITH COTA/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	224Z00000X	Occupational Therapy Assistant	219100	TX

General Provider Information

NPI Number	:	1598612848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY LEANN SMITH COTA/L

Provider Business Mailing Address
First Line	:	4014 GREENBRIDGE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6127
Country	:	US
Telephone Number	:	702-971-8187
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 GREENBRIDGE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6127
Country	:	US
Telephone Number	:	702-971-8187
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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