Provider Demographics
NPI:1639236151
Name:UTAYDE, ALMA BALBON (OTR)
Entity type:Individual
Prefix:MRS
First Name:ALMA
Middle Name:BALBON
Last Name:UTAYDE
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 1:54473 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1849
Mailing Address - Country:US
Mailing Address - Phone:574-386-7555
Mailing Address - Fax:
Practice Address - Street 1:54473 WHITE TAIL DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1849
Practice Address - Country:US
Practice Address - Phone:574-386-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002104A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist