Provider Demographics
NPI:1801369012
Name:BELLUSH, JILL CRISTEN (COTA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CRISTEN
Last Name:BELLUSH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CRISTEN
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 TREE DUCK CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3127
Mailing Address - Country:US
Mailing Address - Phone:724-516-7237
Mailing Address - Fax:
Practice Address - Street 1:LAFAYETTE MANOR, INC
Practice Address - Street 2:147 LAFAYETTE MANOR ROAD
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-430-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA403051224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant