Provider Demographics
NPI:1740582766
Name:BALOUN, BRITTANY LYNN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:LYNN
Last Name:BALOUN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-1990
Mailing Address - Country:US
Mailing Address - Phone:847-710-1223
Mailing Address - Fax:
Practice Address - Street 1:471 W TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3434
Practice Address - Country:US
Practice Address - Phone:224-357-8398
Practice Address - Fax:847-829-4487
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist