Provider Demographics
NPI:1275808057
Name:BETTINGER, ALYSE (OT)
Entity Type:Individual
Prefix:MS
First Name:ALYSE
Middle Name:
Last Name:BETTINGER
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 1:235 DARLING RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4943
Mailing Address - Country:US
Mailing Address - Phone:603-209-1283
Mailing Address - Fax:
Practice Address - Street 1:235 DARLING RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4943
Practice Address - Country:US
Practice Address - Phone:603-209-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0084700225X00000X
NH1579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist