Active NPI
Bethany Ann Kirkland, DROT, OTR/L, ATP
- Occupational Therapist
- Fort Wayne, IN
National Provider Identifier
1114494309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31006337A
- Practice address
- 2121 Lake Ave
Fort Wayne, IN 46805-5100 - Phone
- (800) 360-8387
- NPI assigned
- Oct 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31006337A | IN | Primary |
Addresses
Primary practice location
2121 Lake Ave
Fort Wayne, IN 46805-5100
Mailing address
2121 Lake Ave
Fort Wayne, IN 46805-5100
Phone (800) 360-8387
Other practice location 1
1540 Trinity Pl
Mishawaka, IN 46545-5006
Phone (574) 272-9000
Other practice location 2
750 N Broadway
Peru, IN 46970-1027
Phone (765) 472-8907
Other practice location 3
2600 W White River Blvd
Muncie, IN 47303-5263
Phone (765) 284-6822
Other practice location 4
2606 Peddlers Village Rd
Goshen, IN 46526-1004
Phone (574) 534-6108
Other practice location 5
1700 E 38th St
Marion, IN 46953-4568
Phone (800) 360-8387 ext. 75394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31006337A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695772800000",
"number": "1114494309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "800-360-8387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "800-360-8387"
}
],
"practiceLocations": [
{
"address_1": "1540 Trinity Pl",
"address_purpose": "LOCATION",
"city": "Mishawaka",
"state": "IN",
"postal_code": "465455006",
"country_code": "US",
"telephone_number": "574-272-9000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "750 N Broadway",
"address_purpose": "LOCATION",
"city": "Peru",
"state": "IN",
"postal_code": "469701027",
"country_code": "US",
"telephone_number": "765-472-8907",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2600 W White River Blvd",
"address_purpose": "LOCATION",
"city": "Muncie",
"state": "IN",
"postal_code": "473035263",
"country_code": "US",
"telephone_number": "765-284-6822",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2606 Peddlers Village Rd",
"address_purpose": "LOCATION",
"city": "Goshen",
"state": "IN",
"postal_code": "465261004",
"country_code": "US",
"telephone_number": "574-534-6108",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1700 E 38th St",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "IN",
"postal_code": "469534568",
"country_code": "US",
"telephone_number": "800-360-8387 x75394",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIRKLAND",
"first_name": "BETHANY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DROT, OTR/L, ATP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-26",
"last_updated": "2023-09-27",
"certification_date": "2023-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31006337A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.