Provider Demographics
NPI:1902901663
Name:RYDER, BETTY JANE (OTR)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JANE
Last Name:RYDER
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 1:8812 REVA STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8217
Mailing Address - Country:US
Mailing Address - Phone:214-388-0866
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-0752
Practice Address - Fax:214-857-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist