MEDICARE: DR. SUSAN BETZ OTD, OTR, CHT

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	225XH1200X	Hand Occupational Therapist	AA429654
2	225XH1200X	Hand Occupational Therapist	9105000108

General Provider Information

NPI Number	:	1568464659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN BETZ OTD, OTR, CHT

Provider Business Mailing Address
First Line	:	PO BOX 21150
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80308-4150
Country	:	US
Telephone Number	:	303-808-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 S BANNOCK ST
Second Line	:	SUITE 770
City	:	ENGLEWOOD
State	:	CO
Zip	:	80110-2432
Country	:	US
Telephone Number	:	303-808-7686
Fax Number	:	303-762-9785

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	06/15/2011

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