Basic Information
| Provider Information | |||||||||
| NPI: | 1750958500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETZ | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 BALSAM AVE | ||||||||
| Address2: | |||||||||
| City: | LA CRESCENT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559471517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072591647 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 S HILL ST | ||||||||
| Address2: | |||||||||
| City: | LA CRESCENT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559471389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078954445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 202362 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.