Healthcare Provider Details

I. General information

NPI: 1588657530
Provider Name (Legal Business Name): CHRISTINE BELUSKO MSR-OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 CUMBERLAND LN
ALBANY GA
31721-2145
US

IV. Provider business mailing address

PO BOX 71894
ALBANY GA
31708-1894
US

V. Phone/Fax

Practice location:
  • Phone: 122-944-6894
  • Fax: 122-944-6894
Mailing address:
  • Phone: 229-349-0809
  • Fax: 229-446-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3210
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: