Provider Demographics
NPI:1316370372
Name:BELASCO, MEGAN D (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:BELASCO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7153
Mailing Address - Country:US
Mailing Address - Phone:406-577-6336
Mailing Address - Fax:
Practice Address - Street 1:612 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3726
Practice Address - Country:US
Practice Address - Phone:406-522-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-2616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist