Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004573-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | 004573-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 004573-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 004573-1 | NY |
NPI | 1265709984 |
---|---|
Provider Name | Mrs. Martina Marie Balas |
First Address | Angola, NY 14006-9620 |
Second Address | East Aurora, NY 14052-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 23/11/2011 |