Provider Demographics
NPI:1538280656
Name:BALIBAN, KRISTINA MARIA (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:BALIBAN
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 1:3616 HONEY LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4861
Mailing Address - Country:US
Mailing Address - Phone:215-385-0801
Mailing Address - Fax:
Practice Address - Street 1:1019 EGYPT RD UNIT 2B
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1111
Practice Address - Country:US
Practice Address - Phone:484-214-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019113880002Medicaid