Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5662 | CA |
NPI | 1003907718 |
---|---|
Provider Name | Christina Ann Balogh |
First Address | Milwaukie, OR 97222 |
Second Address | Milwaukie, OR 97222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |