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General NPI Number Information
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NPI Number | 1972672756
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Entity Type | Organization
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Legal Business Name | LIFE BALANCE INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22426 SAINT FRANCIS BLVD
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City | ANOKA
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State | MN
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Zip | 55303-9670
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Country | US
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Telephone | 763-753-2500
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Fax | 763-753-5999
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Provider Business Mailing Address
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Address Line | 30411 152ND ST
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City | PRINCETON
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State | MN
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Zip | 55371-8507
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Country | US
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Telephone | 763-389-8951
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Fax | 763-389-2962
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Authorized Official
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Title or Position | CEO, OCCUPATIONAL THERAPIST
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Name | MS. CASEY SNOW
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Credential | M.A. OT
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Telephone | 763-389-8951
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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 | 102845
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License Number State | MN
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