Provider Demographics
NPI:1124465505
Name:ROE, BETSY LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:LYNN
Last Name:ROE
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 1:2525 HALL RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-9620
Mailing Address - Country:US
Mailing Address - Phone:270-277-5944
Mailing Address - Fax:
Practice Address - Street 1:2525 HALL RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-9620
Practice Address - Country:US
Practice Address - Phone:270-277-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA5509224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant