Brian H Bettorf, COTA-L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.004017 Issued in IL

Practice address

3490 Humbert Rd
Alton, IL 62002-7101

Phone

(618) 465-2626

NPI assigned

Jan 28, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1528699618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56",
            "city": "GRAFTON",
            "state": "IL",
            "postal_code": "620370056",
            "telephone_number": "618-208-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3490 HUMBERT RD",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620027101",
            "telephone_number": "618-465-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTORF",
        "first_name": "BRIAN",
        "middle_name": "H",
        "credential": "COTA-L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.004017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Benhoff, F.N.P.
• Abigail Bennett, DMD
• Sara J Bennett, LCSW
• Alex James Bertman
• Samantha Bettig, MSW,LSW
• Sheri Betts
• Viwathna Bhuthimethee, M.D.
• Bi-State Oral and Facial Surgery, LLC
• Misty D Biciocchi, FNP
• Cody E Bilderback, FNP

• Occupational Therapy Assistant in Alton, IL
• Providers in Alton, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.