Provider Demographics
NPI:1679798631
Name:ANDERSON, BELINDA DENISE
Entity type:Individual
Prefix:MS
First Name:BELINDA
Middle Name:DENISE
Last Name:ANDERSON
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 1:624 E 102ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2202
Mailing Address - Country:US
Mailing Address - Phone:773-882-1648
Mailing Address - Fax:312-506-0103
Practice Address - Street 1:624 E 102ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2202
Practice Address - Country:US
Practice Address - Phone:773-882-1648
Practice Address - Fax:312-506-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics