Provider Demographics
NPI:1669586095
Name:BALESTRERI, KRISTEN MARIE (OT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:BALESTRERI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 LUCIA LN
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4912
Mailing Address - Country:US
Mailing Address - Phone:724-863-4021
Mailing Address - Fax:724-863-4021
Practice Address - Street 1:275 ABBE PL
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1319
Practice Address - Country:US
Practice Address - Phone:724-468-5600
Practice Address - Fax:724-468-5604
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002393L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABA351693OtherHIGHMARK BC/BS/KEYSTONE