Provider Demographics
NPI:1033534060
Name:MCBETH, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MCBETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FIREHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT BOTTOM
Mailing Address - State:PA
Mailing Address - Zip Code:17266-9761
Mailing Address - Country:US
Mailing Address - Phone:717-532-3165
Mailing Address - Fax:
Practice Address - Street 1:1020 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-2158
Practice Address - Country:US
Practice Address - Phone:717-930-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006883224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant