Individual
BETHANY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1595 S CALUMET RD, CHESTERTON, IN 46304-2388
(844) 896-0235
(219) 898-4258
Mailing address
PO BOX 2385, PORTAGE, IN 46368-5885
(844) 896-0235
(219) 898-4258
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31006122A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196020A
—
IN
Enumeration date
06/03/2016
Last updated
02/28/2017
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