Provider Demographics
NPI:1073714747
Name:BETCHAN, JAMIE CAMILLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:CAMILLE
Last Name:BETCHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-5714
Mailing Address - Country:US
Mailing Address - Phone:918-693-1928
Mailing Address - Fax:
Practice Address - Street 1:1008 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-5714
Practice Address - Country:US
Practice Address - Phone:918-693-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPTA 1086225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant