Provider Demographics
NPI:1922466010
Name:O'CONNELL, BETTHNEY (MS,CCC-SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:BETTHNEY
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MS,CCC-SLP, BCBA
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 232
Mailing Address - Street 2:
Mailing Address - City:PATRICK SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24133-0232
Mailing Address - Country:US
Mailing Address - Phone:540-230-1582
Mailing Address - Fax:
Practice Address - Street 1:716 WOOD BROTHERS DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1406
Practice Address - Country:US
Practice Address - Phone:276-694-4488
Practice Address - Fax:276-694-4481
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007816225X00000X
VA2202007243235Z00000X
VA0133000563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist