Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC003575L | PA |
Y | 225XH1200X | Occupational Therapist - Hand | OC003575L | PA |
NPI | 1245788280 |
---|---|
Provider Name | Betsy Green |
First Address | Allentown, PA 18104-9147 |
Second Address | Allentown, PA 18104-9147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2016 |
Last Update Date | 20/09/2016 |