Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1349 | WV |
NPI | 1003094343 |
---|---|
Provider Name | Mrs. Jaclyn Michele Belcastro |
First Address | Bridgeport, WV 26330-1375 |
Second Address | Bridgeport, WV 26330-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2008 |
Last Update Date | 03/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810010303 | (05) | WV |