Provider Demographics
NPI:1669028064
Name:BELISLE, RENEE YVETTE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:YVETTE
Last Name:BELISLE
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 1:85 BARDIN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2839
Mailing Address - Country:US
Mailing Address - Phone:508-904-6162
Mailing Address - Fax:
Practice Address - Street 1:1266 FURNANCE BROOK PARKWAY
Practice Address - Street 2:SUITE #100B
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-433-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12246225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics