Provider Demographics
NPI:1144616772
Name:HUMPHREYS, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HUMPHREYS
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 1:95 SENATE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1520
Mailing Address - Country:US
Mailing Address - Phone:860-228-8201
Mailing Address - Fax:
Practice Address - Street 1:59 HARRINGTON CT
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1207
Practice Address - Country:US
Practice Address - Phone:860-537-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0527224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant