Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | R3680 | KY |
NPI | 1083079032 |
---|---|
Provider Name | Mrs. Bethanie Skaggs-Manley |
First Address | Georgetown, KY 40324-9610 |
Second Address | Georgetown, KY 40324-9610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 17/12/2015 |