Provider Demographics
NPI:1104268556
Name:FLOWERS, BETSY GRAY (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:GRAY
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 NORTHGATE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3190
Mailing Address - Country:US
Mailing Address - Phone:804-897-9850
Mailing Address - Fax:804-897-0395
Practice Address - Street 1:207 NORTHGATE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3190
Practice Address - Country:US
Practice Address - Phone:804-897-9850
Practice Address - Fax:804-897-0395
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01314000070224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN/AOtherN/A