Provider Demographics
NPI:1285078840
Name:BELLUCCI, CHRISTOPHER ROBERT (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:BELLUCCI
Suffix:
Gender:M
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 1:4130 DUTCHMANS LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4710
Mailing Address - Country:US
Mailing Address - Phone:502-897-1794
Mailing Address - Fax:502-897-3852
Practice Address - Street 1:4130 DUTCHMANS LN STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4708
Practice Address - Country:US
Practice Address - Phone:502-897-1794
Practice Address - Fax:502-897-3852
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007089A225X00000X
KYR5546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30006426Medicaid
KY7100377600Medicaid