Healthcare Provider Details

I. General information

NPI: 1003247727
Provider Name (Legal Business Name): BETSY GEDDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W MAIN ST
WEST JEFFERSON OH
43162-1298
US

IV. Provider business mailing address

375 W MAIN ST
WEST JEFFERSON OH
43162-1298
US

V. Phone/Fax

Practice location:
  • Phone: 740-879-7661
  • Fax: 740-879-7604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 05317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: