Provider Demographics
NPI:1497996268
Name:BALASUNDRAM, REUBEN S (OTR/L, ATP, CAPS)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:S
Last Name:BALASUNDRAM
Suffix:
Gender:M
Credentials:OTR/L, ATP, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:6 S MADDER DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7954
Mailing Address - Country:US
Mailing Address - Phone:717-791-0513
Mailing Address - Fax:717-918-2020
Practice Address - Street 1:6 S MADDER DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7954
Practice Address - Country:US
Practice Address - Phone:717-791-0513
Practice Address - Fax:717-918-2020
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225CA2400X, 225CX0006X
PAOC008552225X00000X, 225XE0001X, 225XF0002X, 225XG0600X, 225XN1300X, 225XP0019X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA148766ZC8RMedicare PIN
PA148654Medicare PIN