Provider Demographics
NPI:1285883264
Name:DEBELLIS, KATHLEEN MARY
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:DEBELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6299 CROSSWINDS CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2029
Mailing Address - Country:US
Mailing Address - Phone:716-741-3787
Mailing Address - Fax:
Practice Address - Street 1:6299 CROSSWINDS CT
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2029
Practice Address - Country:US
Practice Address - Phone:716-741-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002835-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant