Healthcare Provider Details

I. General information

NPI: 1396326393
Provider Name (Legal Business Name): TARYN ANN BETKA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

IV. Provider business mailing address

9712 NE SUNDERLAND DR
HILLSBORO OR
97124-9100
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number438990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: