Bethany Makayla Lady Wines, OT/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

14742 Issued in NC

Practice address

134 Infield CT
Mooresville, NC 28117-8026

Phone

(704) 799-6824

Fax

(704) 799-6825

NPI assigned

Feb 21, 2022

Last updated

Apr 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrative Therapy Concepts

  • Pediatric Occupational Therapist
  • Mooresville, NC
  • NPI 1508849332
  NPD (past)
• Lolly Therapeutics, LLC

  • Occupational Therapist
  • Mooresville, NC
  • NPI 1164847752
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1033864830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INFIELD CT",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178026",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 INFIELD CT",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178026",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 N Tradd St",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286775239",
            "country_code": "US",
            "telephone_number": "704-380-0799",
            "fax_number": "704-278-0146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WINES",
        "first_name": "BETHANY",
        "middle_name": "MAKAYLA LADY",
        "credential": "OT/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "14742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clifford Wilson, LCMHC
• James David Wilson, MD
• Jasmine Patterson Wilson
• Katherine F Wilson, PHARM D
• Victoria Wilson, FNP-C
• Jessica Rose Wing, MA, LCMHCA, NCC
• Jodi Winkelvoss, OTR/L
• Amy Majors Winstead, CNM
• With Gods Help, Licensed Clinical Social Work, LLC
• With Gods Help2 Licensed Clinical Social Work, PLLC

• Occupational Therapist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.