Provider Demographics
NPI:1093472334
Name:BETKOWSKI, JACOB (OTR)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:BETKOWSKI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2132
Mailing Address - Country:US
Mailing Address - Phone:732-320-6285
Mailing Address - Fax:732-374-9864
Practice Address - Street 1:144 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2132
Practice Address - Country:US
Practice Address - Phone:732-320-6285
Practice Address - Fax:732-374-9864
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01028500225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR01028500OtherLICENSE