Healthcare Provider Details

I. General information

NPI: 1013304930
Provider Name (Legal Business Name): ELLEN MARIE BETLEY LPN COFM CFTS COF CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HILLTOP AVE
NORRISTOWN PA
19401-1333
US

IV. Provider business mailing address

119 HILLTOP AVE
NORRISTOWN PA
19401-1333
US

V. Phone/Fax

Practice location:
  • Phone: 610-766-1246
  • Fax: 610-292-8872
Mailing address:
  • Phone: 610-766-1246
  • Fax: 610-292-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOF000008
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberPD000007
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN078185L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: