MEDICARE: BETHANY ALYSE HASSON

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	018279	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018279-1	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1831688274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ALYSE HASSON

Provider Business Mailing Address
First Line	:	1286 SOUTHWESTERN DR
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-9430
Country	:	US
Telephone Number	:	716-338-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 N MAPLE AVE
Second Line	:
City	:	ASHVILLE
State	:	NY
Zip	:	14710-9553
Country	:	US
Telephone Number	:	716-763-1801
Fax Number	:

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

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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