Provider Demographics
NPI:1003094343
Name:BELCASTRO, JACLYN MICHELE (MS,OT R/L)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MICHELE
Last Name:BELCASTRO
Suffix:
Gender:F
Credentials:MS,OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 STATE ST.
Mailing Address - Street 2:BEST LIFE THERAPY LLC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1375
Mailing Address - Country:US
Mailing Address - Phone:304-933-3073
Mailing Address - Fax:304-933-3187
Practice Address - Street 1:141 STATE ST.
Practice Address - Street 2:BEST LIFE THERAPY LLC
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1375
Practice Address - Country:US
Practice Address - Phone:304-933-3073
Practice Address - Fax:304-933-3187
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010303Medicaid