Provider Demographics
NPI:1144973660
Name:BELLE, CLINTON LEON (OTR)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:LEON
Last Name:BELLE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5916
Mailing Address - Country:US
Mailing Address - Phone:347-998-4151
Mailing Address - Fax:
Practice Address - Street 1:500 DEKALB AVE
Practice Address - Street 2:STE 401B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4808
Practice Address - Country:US
Practice Address - Phone:518-240-5283
Practice Address - Fax:718-228-5233
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist