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NPI Code Detail

MEDICARE: BETHANY MARIE MCMILLEN OT

MEDICARE: BETHANY MARIE MCMILLEN OT
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 Therapist60920416WA
2225X00000XOccupational Therapist2018030897MO

General Provider Information

NPI Number : 1952965303
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY MARIE MCMILLEN OT
Provider Business Mailing Address
First Line : 230 SUMMIT RIDGE PL
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-0907
Country : US
Telephone Number : 636-699-5548
Fax Number :
Provider Business Practice Location Address
First Line : 1310 NW DEANE ST
Second Line :
City : PULLMAN
State : WA
Zip : 99163-3705
Country : US
Telephone Number : 509-332-1566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2019
Last Update Date : 04/30/2019

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