Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4289 | NC |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4289 | NC |
NPI | 1366043788 |
---|---|
Provider Name | Peter Balent |
First Address | Kinston, NC 28501-1604 |
Second Address | Kinston, NC 28501-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2020 |
Last Update Date | 03/11/2020 |