Individual
BETHANY MAKAYLA LADY WINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
134 INFIELD CT, MOORESVILLE, NC 28117-8026
(704) 799-6824
(704) 799-6825
Mailing address
134 INFIELD CT, MOORESVILLE, NC 28117-8026
(704) 799-6824
(704) 799-6825
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
14742
NC
Other
Enumeration date
02/21/2022
Last updated
04/15/2022
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