Provider Demographics
NPI:1083113872
Name:WHOLEPERSON THERAPEUTICS LLC
Entity Type:Organization
Organization Name:WHOLEPERSON THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JOANNA
Authorized Official - Last Name:BELICIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:203-636-0065
Mailing Address - Street 1:1000 BRIDGEPORT AVENUE
Mailing Address - Street 2:STE. 306
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-636-0065
Mailing Address - Fax:203-399-0006
Practice Address - Street 1:1000 BRIDGEPORT AVE FL 3
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4660
Practice Address - Country:US
Practice Address - Phone:203-306-9612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008078763Medicaid