Provider Demographics
NPI:1689343022
Name:BELLEFY, MEGAN DALE
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:DALE
Last Name:BELLEFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 RED LAKE AVE NW
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8725
Mailing Address - Country:US
Mailing Address - Phone:218-358-0399
Mailing Address - Fax:
Practice Address - Street 1:123 RED LAKE AVE NW
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-8725
Practice Address - Country:US
Practice Address - Phone:218-358-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist