=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790091379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARICE NICOLE BECHTLE P.T.A., M.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2010
-----------------------------------------------------
Last Update Date | 07/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 EMMA LN
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10926-3323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-283-1914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 392
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10926-0392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-283-1914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 3798-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 14699
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------