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: | |
Other - Last Name Type: | |
Other - Credentials: | |
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
State | License ID | Taxonomies |
---|---|---|
PA | 225CA2400X, 225CX0006X | |
PA | OC008552 | 225X00000X, 225XE0001X, 225XF0002X, 225XG0600X, 225XN1300X, 225XP0019X, 225XR0403X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225CA2400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Practitioner |
No | 225CX0006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Orientation and Mobility Training Provider |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 148766ZC8R | Medicare PIN | |
PA | 148654 | Medicare PIN |