Provider Demographics
NPI:1144366998
Name:BELCKE, MARIANNE SWAB (OTRL)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:SWAB
Last Name:BELCKE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CLARENDON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4502
Mailing Address - Country:US
Mailing Address - Phone:314-265-5231
Mailing Address - Fax:636-443-2142
Practice Address - Street 1:373 CLARENDON LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4502
Practice Address - Country:US
Practice Address - Phone:314-265-5231
Practice Address - Fax:636-443-2142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist