Provider Demographics
NPI:1023449345
Name:BELANGER, KIERSTEN (OTR/L)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:BELANGER
Suffix:
Gender:F
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 1:256 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4416
Mailing Address - Country:US
Mailing Address - Phone:860-666-5689
Mailing Address - Fax:
Practice Address - Street 1:256 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4416
Practice Address - Country:US
Practice Address - Phone:860-666-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003587225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation