Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4056 | MT |
N | 225X00000X | Occupational Therapist | 6048 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 6048 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 6048 | CA |
NPI | 1134499346 |
---|---|
Provider Name | Amanda Balser |
First Address | Missoula, MT 59812-0001 |
Second Address | Nevada City, CA 95959-2947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2012 |
Last Update Date | 10/09/2019 |