Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0001831 | NJ |
NPI | 1033469952 |
---|---|
Provider Name | Ms. Bonnie Betts |
First Address | Tacoma, WA 98444-5044 |
Second Address | Tacoma, WA 98444-5044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 18/09/2012 |