Provider Demographics
NPI:1942632476
Name:CHEN, BETTY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20895 HEATHERVIEW
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7256
Mailing Address - Country:US
Mailing Address - Phone:714-797-6100
Mailing Address - Fax:
Practice Address - Street 1:20895 HEATHERVIEW
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7256
Practice Address - Country:US
Practice Address - Phone:714-797-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 10803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist