Provider Demographics
NPI:1821043282
Name:BELENKOVA, LIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LIA
Middle Name:
Last Name:BELENKOVA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S 4TH ST
Mailing Address - Street 2:B160 G-105
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5014
Mailing Address - Country:US
Mailing Address - Phone:913-682-2000
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:D-110
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:913-758-4149
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01792225X00000X
MO2000148404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist