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General NPI Number Information
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NPI Number | 1326441007
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Entity Type | Individual
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Provider Name | JACLYN BALTERA
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 100 SUNSET DR
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-9403
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Country | US
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Telephone | 919-562-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 441 SLOMO CT
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City | WAKE FOREST
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State | NC
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Zip | 27587-3534
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Country | US
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Telephone |
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Fax |
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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 | 14304
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License Number State | NC
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