Provider Demographics
NPI:1568001485
Name:TANKERSLEY, BELINDA REGINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:REGINA
Last Name:TANKERSLEY
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 1:3330 SUGARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0624
Mailing Address - Country:US
Mailing Address - Phone:706-564-2457
Mailing Address - Fax:
Practice Address - Street 1:724 GREENE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2359
Practice Address - Country:US
Practice Address - Phone:706-722-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist