Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2951 | GA |
NPI | 1134111982 |
---|---|
Provider Name | Mr. Eric S. Belusko |
First Address | Albany, GA 31707-2370 |
Second Address | Albany, GA 31707-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52887554-001 | BCBS (01) | GA |
983491647A | (05) | GA |
Q43819 | (02) | GA |