Provider Demographics
NPI:1942676507
Name:BALAS, TARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BALAS
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 1:8685 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9620
Mailing Address - Country:US
Mailing Address - Phone:716-549-4454
Mailing Address - Fax:716-549-0217
Practice Address - Street 1:8685 ERIE RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9620
Practice Address - Country:US
Practice Address - Phone:716-549-4454
Practice Address - Fax:716-549-0217
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist