MEDICARE: REBECCA BALOG OTR/L

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	0119006829	VA

General Provider Information

NPI Number	:	1558804062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BALOG OTR/L

Provider Business Mailing Address
First Line	:	1919 REDROSE DR
Second Line	:
City	:	MAIDENS
State	:	VA
Zip	:	23102-2127
Country	:	US
Telephone Number	:	804-476-4380
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 REDROSE DR
Second Line	:
City	:	MAIDENS
State	:	VA
Zip	:	23102-2127
Country	:	US
Telephone Number	:	804-476-4380
Fax Number	:

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	11/11/2025

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