Provider Demographics
NPI:1043985849
Name:BALSAMO, SAVANNAH PAIGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:PAIGE
Last Name:BALSAMO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 INNSBRUCK DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-8949
Mailing Address - Country:US
Mailing Address - Phone:401-632-5703
Mailing Address - Fax:
Practice Address - Street 1:1022 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4234
Practice Address - Country:US
Practice Address - Phone:401-632-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty