Provider Demographics
NPI:1760934723
Name:BELLI, JACKIE ELAINE
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ELAINE
Last Name:BELLI
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 1:9719 PERSIMMON PL
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9776
Mailing Address - Country:US
Mailing Address - Phone:614-370-6591
Mailing Address - Fax:
Practice Address - Street 1:7030 COFFMAN RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1068
Practice Address - Country:US
Practice Address - Phone:614-764-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003532225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics