Provider Demographics
NPI:1124746268
Name:GRANJA BETANCOURT, MARLENE (OTR)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:GRANJA BETANCOURT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 DALLAS PKWY APT 1136
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8347
Mailing Address - Country:US
Mailing Address - Phone:469-570-1845
Mailing Address - Fax:
Practice Address - Street 1:6350 WINTER PARK DR
Practice Address - Street 2:
Practice Address - City:N RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5363
Practice Address - Country:US
Practice Address - Phone:817-482-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist