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General NPI Number Information
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NPI Number | 1356146773
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Entity Type | Organization
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Legal Business Name | ORTHO THERAPEUTICS AND WELLNESS, LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 98 N WASHINGTON ST STE 107
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City | BOSTON
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State | MA
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Zip | 02114-1913
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Country | US
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Telephone | 617-921-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 57 ELM ST
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City | CHARLESTOWN
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State | MA
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Zip | 02129-2421
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Country | US
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Telephone | 617-921-0962
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Fax |
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Authorized Official
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Title or Position | OWNER/APRN
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Name | MARYELLEN BELISLE
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Credential | NP
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Telephone | 617-921-0962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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