Healthcare Provider Details

I. General information

NPI: 1407162159
Provider Name (Legal Business Name): BETSY LYNN PRIESTER C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 NORTH MAIN STREET
WELLSVILLE NY
14895
US

IV. Provider business mailing address

8435 ROUTE 16N
FRANKLINVILLE NY
14737
US

V. Phone/Fax

Practice location:
  • Phone: 585-596-4011
  • Fax:
Mailing address:
  • Phone: 716-353-1035
  • Fax: 716-676-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001656-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: