Provider Demographics
NPI:1023748209
Name:BETTENCOURT, CHLOE (MS, OT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ALLEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-3521
Mailing Address - Country:US
Mailing Address - Phone:603-560-9339
Mailing Address - Fax:
Practice Address - Street 1:85 MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1500
Practice Address - Country:US
Practice Address - Phone:603-236-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty