Healthcare Provider Details

I. General information

NPI: 1114229929
Provider Name (Legal Business Name): KIM T BETANCOURT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM ORANSKY

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 S VAL VISTA DR
GILBERT AZ
85295-5570
US

IV. Provider business mailing address

18724 E SWAN DR
QUEEN CREEK AZ
85142-7990
US

V. Phone/Fax

Practice location:
  • Phone: 347-992-4793
  • Fax:
Mailing address:
  • Phone: 347-992-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4424
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: