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General NPI Number Information
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NPI Number | 1033594759
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Entity Type | Individual
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Provider Name | KELLIE BROOKE BELCHER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 817 WOODLAND DR.
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City | STUART
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State | VA
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Zip | 24171
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Country | US
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Telephone | 276-694-8628
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Fax |
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Provider Business Mailing Address
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Address Line | 205 MOUNTAIN VALLEY DR
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City | PATRICK SPRINGS
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State | VA
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Zip | 24133-3780
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Country | US
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Telephone | 276-694-3705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 345278
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License Number State | VA
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