Provider Demographics
NPI:1053868299
Name:AIKEN, BETHANY (OT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:AIKEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 OXMOOR RDG
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6033
Mailing Address - Country:US
Mailing Address - Phone:919-619-4369
Mailing Address - Fax:
Practice Address - Street 1:169 HIGHWAY 6 E
Practice Address - Street 2:SUITE 102
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9415
Practice Address - Country:US
Practice Address - Phone:662-380-5030
Practice Address - Fax:662-380-5620
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist