Individual
STACIE BELLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(701) 403-1120
Mailing address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(701) 403-1120
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201770
MN
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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