Provider Demographics
NPI:1013304930
Name:BETLEY, ELLEN MARIE (LPN COFM CFTS COF CP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:BETLEY
Suffix:
Gender:F
Credentials:LPN COFM CFTS COF CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1333
Mailing Address - Country:US
Mailing Address - Phone:610-766-1246
Mailing Address - Fax:610-292-8872
Practice Address - Street 1:119 HILLTOP AVE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1333
Practice Address - Country:US
Practice Address - Phone:610-766-1246
Practice Address - Fax:610-292-8872
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOF000008225000000X
PAPD000007224L00000X
PAPN078185L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No164W00000XNursing Service ProvidersLicensed Practical Nurse