Provider Demographics
NPI:1447986609
Name:CLAIR, BETHANY (COTA/L)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:CLAIR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9091
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9091
Mailing Address - Country:US
Mailing Address - Phone:479-692-3640
Mailing Address - Fax:
Practice Address - Street 1:5507 W WALSH LN #102
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8951
Practice Address - Country:US
Practice Address - Phone:479-367-2806
Practice Address - Fax:479-367-2648
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1831224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant