MEDICARE: ELVA JANETTE BALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	13903889-4003	UT

General Provider Information

NPI Number	:	1306694328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVA JANETTE BALES

Provider Business Mailing Address
First Line	:	1884 LITTLE VALLEY RD
Second Line	:
City	:	WALLSBURG
State	:	UT
Zip	:	84082-9782
Country	:	US
Telephone Number	:	707-628-9056
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 E 1200 S
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-4497
Country	:	US
Telephone Number	:	435-654-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “ ELVA JANETTE BALES ” Practice Location

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