MEDICARE: MISS JAMIE CAMILLE BETCHAN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA 1086	OK

General Provider Information

NPI Number	:	1073714747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE CAMILLE BETCHAN PTA

Provider Business Mailing Address
First Line	:	1008 WILLOW ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-5714
Country	:	US
Telephone Number	:	918-693-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 WILLOW ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-5714
Country	:	US
Telephone Number	:	918-693-1928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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