Provider Demographics
NPI:1891225454
Name:LEBEAU, BETSY MAY
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:MAY
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:MAY
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42658 TWP 1153
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844
Mailing Address - Country:US
Mailing Address - Phone:740-294-4993
Mailing Address - Fax:
Practice Address - Street 1:24658 TWP 1153
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844
Practice Address - Country:US
Practice Address - Phone:740-294-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-2386224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant