Provider Demographics
NPI:1235538943
Name:FIT LIFE OCCUPATIONAL THERAPY P.C.
Entity Type:Organization
Organization Name:FIT LIFE OCCUPATIONAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:718-414-5838
Mailing Address - Street 1:2928 W 5TH ST
Mailing Address - Street 2:APT 21M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3902
Mailing Address - Country:US
Mailing Address - Phone:718-414-5838
Mailing Address - Fax:
Practice Address - Street 1:2928 W 5TH ST
Practice Address - Street 2:APT 21M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3902
Practice Address - Country:US
Practice Address - Phone:718-414-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty