Individual
BRIAN H BETTORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA-L
Contact information
Practice address
3490 HUMBERT RD, ALTON, IL 62002-7101
(618) 465-2626
Mailing address
PO BOX 56, GRAFTON, IL 62037-0056
(618) 208-1435
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004017
IL
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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