Provider Demographics
NPI:1992099923
Name:BELLUSO, CRYSTAL JEANNE (MOT OTR/L)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JEANNE
Last Name:BELLUSO
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 BEDFORD ST APT B5
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1897
Mailing Address - Country:US
Mailing Address - Phone:401-556-2617
Mailing Address - Fax:
Practice Address - Street 1:308 KINGS TOWN WAY
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4647
Practice Address - Country:US
Practice Address - Phone:781-585-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist