Provider Demographics
NPI:1942770797
Name:BELDEN, KATIE L (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:BELDEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MONISA KAY DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1466
Mailing Address - Country:US
Mailing Address - Phone:508-208-1912
Mailing Address - Fax:
Practice Address - Street 1:30 MONISA KAY DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1466
Practice Address - Country:US
Practice Address - Phone:508-208-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12997OtherMASSACHUSETTS BOARD OF ALLIED HEALTH