Provider Demographics
NPI:1053514745
Name:DEASON, BETHANY (OTRL, MHS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DEASON
Suffix:
Gender:F
Credentials:OTRL, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROOSEVELT WARM SPRINGS INSTITUTE FOR REHABILITATION
Practice Address - Street 2:6135 ROOSEVELT HWY
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-1000
Practice Address - Country:US
Practice Address - Phone:706-655-5636
Practice Address - Fax:706-655-5661
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist