Provider Demographics
NPI:1740919208
Name:BELK, AMY JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:BELK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 SHADOW CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1145
Mailing Address - Country:US
Mailing Address - Phone:909-557-8991
Mailing Address - Fax:
Practice Address - Street 1:9320 BASE LINE RD STE B1
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5829
Practice Address - Country:US
Practice Address - Phone:909-652-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT23349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist