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NPI Code Detail

MEDICARE: MARY BALCH

MEDICARE: MARY BALCH
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
1225X00000XOccupational TherapistMS

General Provider Information

NPI Number : 1346579646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BALCH
Provider Business Mailing Address
First Line : 4109 HIGHWAY 98 W
Second Line :
City : SUMMIT
State : MS
Zip : 39666-9132
Country : US
Telephone Number : 601-276-3900
Fax Number :
Provider Business Practice Location Address
First Line : 1007 GLENWOOD DR
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-5501
Country : US
Telephone Number : 318-235-6852
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2009
Last Update Date : 12/30/2016

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Directions to “ MARY BALCH ” Practice Location

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