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NPI Code Detail

MEDICARE: BETH INGRAM & ASSOCIATES, LLC

MEDICARE: BETH INGRAM & ASSOCIATES, LLC
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
1225X00000XOccupational Therapist
22355S0801XSpeech-Language Assistant
3224Z00000XOccupational Therapy Assistant
4225100000XPhysical Therapist
5235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1912613134
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETH INGRAM & ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 602 VONDERBURG DR STE 201
Second Line :
City : BRANDON
State : FL
Zip : 33511-5900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4222 S FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33813-1628
Country : US
Telephone Number : 813-653-1149
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : VANESSA BANKS
Credential :
Telephone Number : 813-508-2991
Provider Enumeration Date : 01/31/2023
Last Update Date : 06/06/2024

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Directions to “BETH INGRAM & ASSOCIATES, LLC ” Practice Location

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