Provider Demographics
NPI:1912364019
Name:DYER, BETTY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTSMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41174-0466
Mailing Address - Country:US
Mailing Address - Phone:606-932-3127
Mailing Address - Fax:
Practice Address - Street 1:405 SM ROBERSON DR
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-9678
Practice Address - Country:US
Practice Address - Phone:606-932-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist