Provider Demographics
NPI:1134443971
Name:BALEK, JANE M (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:M
Last Name:BALEK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MEADOWLARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633-9317
Mailing Address - Country:US
Mailing Address - Phone:417-723-5281
Mailing Address - Fax:
Practice Address - Street 1:509 MEADOWLARK AVE
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633-9317
Practice Address - Country:US
Practice Address - Phone:417-723-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017037224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009017037OtherCOTA LICENSE MO