MEDICARE: KELLY BETTES 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	225X00000X	Occupational Therapist
2	225XH1200X	Hand Occupational Therapist	106559	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106559	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1932214202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BETTES OTR/CHT

Provider Business Mailing Address
First Line	:	17360 NORTHWEST FWY
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77040-1114
Country	:	US
Telephone Number	:	713-849-2253
Fax Number	:

Provider Business Practice Location Address
First Line	:	17360 NORTHWEST FWY
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77040-1114
Country	:	US
Telephone Number	:	713-849-2253
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	06/06/2014

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