Provider Demographics
NPI:1871802967
Name:CLARKE-BETTICA, NANCY (OTR)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:CLARKE-BETTICA
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 1:1290 E 19TH ST
Mailing Address - Street 2:2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5461
Mailing Address - Country:US
Mailing Address - Phone:718-951-1081
Mailing Address - Fax:
Practice Address - Street 1:113 LINDEN ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2621
Practice Address - Country:US
Practice Address - Phone:516-374-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002132-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics