Provider Demographics
NPI: | 1932214202 |
---|---|
Name: | BETTES, KELLY (OTR/CHT) |
Entity Type: | Individual |
Prefix: | |
First Name: | KELLY |
Middle Name: | |
Last Name: | BETTES |
Suffix: | |
Gender: | F |
Credentials: | OTR/CHT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 17360 NORTHWEST FWY |
Mailing Address - Street 2: | |
Mailing Address - City: | JERSEY VILLAGE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77040-1114 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-849-2253 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 17360 NORTHWEST FWY |
Practice Address - Street 2: | |
Practice Address - City: | JERSEY VILLAGE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77040-1114 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-849-2253 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-20 |
Last Update Date: | 2014-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
225X00000X | ||
TX | 106559 | 225XH1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 106559 | Other | LICENSE # |