Provider Demographics
NPI:1114171402
Name:BALABAN, TAMARA M (OTR)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:M
Last Name:BALABAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 COLUMBUS AVE
Mailing Address - Street 2:#7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5901
Mailing Address - Country:US
Mailing Address - Phone:646-306-7506
Mailing Address - Fax:
Practice Address - Street 1:784 COLUMBUS AVE
Practice Address - Street 2:#7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5901
Practice Address - Country:US
Practice Address - Phone:646-306-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014614225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics