Provider Demographics
NPI:1013188218
Name:KENNEDY, BETSY JEAN (MS, OTR, CLT)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:JEAN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 LYMAN LN
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5338
Mailing Address - Country:US
Mailing Address - Phone:608-455-1644
Mailing Address - Fax:
Practice Address - Street 1:2722 LYMAN LN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5338
Practice Address - Country:US
Practice Address - Phone:608-455-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3930-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist