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General NPI Number Information
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NPI Number | 1609201524
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Entity Type | Organization
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Legal Business Name | BALANCED HOME THERAPY SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 4750 RIDGE LN
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City | KEWADIN
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State | MI
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Zip | 49648-9338
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Country | US
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Telephone | 231-883-9822
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Fax | 231-264-0268
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Provider Business Mailing Address
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Address Line | 4750 RIDGE LN
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City | KEWADIN
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State | MI
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Zip | 49648-9338
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Country | US
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Telephone | 231-883-9822
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Fax | 231-264-0268
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Authorized Official
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Title or Position | OWNER
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Name | KARA KOEPLIN
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Credential | O.T.
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Telephone | 231-883-9822
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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 | 5201006276
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License Number State | MI
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