Provider Demographics
NPI:1134499346
Name:BALSER, AMANDA (OTR/L, ATP/SMS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BALSER
Suffix:
Gender:F
Credentials:OTR/L, ATP/SMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAMPUS DR SKAGGS BLDG STE 129
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2947
Practice Address - Country:US
Practice Address - Phone:530-265-8100
Practice Address - Fax:530-265-8112
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6048225X00000X, 225XN1300X, 225XP0019X
MT4056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation