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General NPI Number Information
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NPI Number | 1336636257
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Entity Type | Organization
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Legal Business Name | THE BALANCED KID, INC.
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 825 N CASS AVE STE 109
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City | WESTMONT
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State | IL
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Zip | 60559-6401
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Country | US
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Telephone | 630-399-3232
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Fax | 331-457-4323
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Provider Business Mailing Address
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Address Line | 26W333 BAUER RD
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City | NAPERVILLE
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State | IL
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Zip | 60563-2820
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Country | US
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Telephone | 630-399-3232
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHRISTINE DAWN JURJOVEC
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Credential | OTR/L
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Telephone | 630-399-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056-006463
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License Number State | IL
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