Provider Demographics
NPI:1053757476
Name:KOLTON, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 MENLO CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5031
Mailing Address - Country:US
Mailing Address - Phone:775-762-9814
Mailing Address - Fax:
Practice Address - Street 1:3329 MENLO CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5031
Practice Address - Country:US
Practice Address - Phone:775-762-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner