Provider Demographics
NPI:1205295961
Name:BELLIVEAU, COTEY
Entity type:Individual
Prefix:
First Name:COTEY
Middle Name:
Last Name:BELLIVEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-0117
Mailing Address - Country:US
Mailing Address - Phone:978-514-2202
Mailing Address - Fax:
Practice Address - Street 1:120 WATER ST
Practice Address - Street 2:APT 532
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3260
Practice Address - Country:US
Practice Address - Phone:978-514-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program