Provider Demographics
NPI:1316365984
Name:BETTS, JEANNE (LMP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 8TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2024
Mailing Address - Country:US
Mailing Address - Phone:253-702-6122
Mailing Address - Fax:
Practice Address - Street 1:8702 8TH WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-2024
Practice Address - Country:US
Practice Address - Phone:253-702-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist