Provider Demographics
NPI:1033594759
Name:BELCHER, KELLIE BROOKE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:BROOKE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MOUNTAIN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PATRICK SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24133-3780
Mailing Address - Country:US
Mailing Address - Phone:276-694-3705
Mailing Address - Fax:
Practice Address - Street 1:817 WOODLAND DR.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA345278224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant