Provider Demographics
NPI:1235129123
Name:RENFROW-BETKER, LISA (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RENFROW-BETKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BEECHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-8903
Mailing Address - Country:US
Mailing Address - Phone:502-367-9523
Mailing Address - Fax:
Practice Address - Street 1:68 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2318
Practice Address - Country:US
Practice Address - Phone:828-277-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0922916Medicaid
KY8800049200Medicare ID - Type Unspecified