Provider Demographics
NPI:1093412389
Name:BALKIN, JORDAN TAYLOR (OTD, OTR/L, CTRI)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TAYLOR
Last Name:BALKIN
Suffix:
Gender:F
Credentials:OTD, OTR/L, CTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RICHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9800
Mailing Address - Country:US
Mailing Address - Phone:716-783-6434
Mailing Address - Fax:
Practice Address - Street 1:108 RICHWOOD CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9800
Practice Address - Country:US
Practice Address - Phone:716-783-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10767381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist