Healthcare Provider Details

I. General information

NPI: 1023929585
Provider Name (Legal Business Name): BELGIE OTHELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MAGNA RD
METHUEN MA
01844-4654
US

IV. Provider business mailing address

22 MAGNA RD
METHUEN MA
01844-4654
US

V. Phone/Fax

Practice location:
  • Phone: 857-246-5352
  • Fax:
Mailing address:
  • Phone: 857-246-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2391104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: