Provider Demographics
NPI:1215325329
Name:BELICIA, BARBARA JOANNA (OTRL)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOANNA
Last Name:BELICIA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BRIDGEPORT AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4676
Mailing Address - Country:US
Mailing Address - Phone:203-360-0065
Mailing Address - Fax:203-242-8348
Practice Address - Street 1:1000 BRIDGEPORT AVENUE
Practice Address - Street 2:STE. 306
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-360-0065
Practice Address - Fax:203-399-0006
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004280225X00000X, 225XE0001X, 225XG0600X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1215325329Medicaid