Provider Demographics
NPI:1467875682
Name:BALES, ERIN (OT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8646 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9004
Mailing Address - Country:US
Mailing Address - Phone:937-402-0914
Mailing Address - Fax:
Practice Address - Street 1:8646 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9004
Practice Address - Country:US
Practice Address - Phone:937-402-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist