MEDICARE: ERIN BALES OT

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	225X00000X	Occupational Therapist	005900	OH

General Provider Information

NPI Number	:	1467875682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN BALES OT

Provider Business Mailing Address
First Line	:	8646 OAK GROVE RD
Second Line	:
City	:	LEESBURG
State	:	OH
Zip	:	45135-9004
Country	:	US
Telephone Number	:	937-402-0914
Fax Number	:

Provider Business Practice Location Address
First Line	:	8646 OAK GROVE RD
Second Line	:
City	:	LEESBURG
State	:	OH
Zip	:	45135-9004
Country	:	US
Telephone Number	:	937-402-0914
Fax Number	:

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

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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