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General NPI Number Information
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NPI Number | 1225306244
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Entity Type | Individual
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Provider Name | JOHN LEWIS BALSAMO O.T.R
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Gender | Male
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 1 BOONE RD
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City | BREMERTON
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State | WA
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Zip | 98312-1894
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Country | US
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Telephone | 360-475-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4159
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Fax | 910-450-4194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR00339000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 117189
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License Number State | TX
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