Provider Demographics
NPI:1790798312
Name:JOCKISCH, BELINDA H
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:H
Last Name:JOCKISCH
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 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-212-9435
Practice Address - Fax:205-212-3299
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534949OtherBCBS OF AL
AL630649108469PTOtherVIVA
AL92719OtherBCBS OF AL
AL051534949OtherBCBS OF AL
AL102I672854Medicare PIN