Provider Demographics
NPI:1750664009
Name:BELLIS, CARRI LIN
Entity Type:Individual
Prefix:MRS
First Name:CARRI
Middle Name:LIN
Last Name:BELLIS
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 1:1020 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6290
Mailing Address - Country:US
Mailing Address - Phone:217-224-9832
Mailing Address - Fax:217-224-9836
Practice Address - Street 1:1020 S 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-6290
Practice Address - Country:US
Practice Address - Phone:217-224-9832
Practice Address - Fax:217-224-9836
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist