Provider Demographics
NPI:1801351861
Name:BALCOM, HALEY JEAN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:JEAN
Last Name:BALCOM
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 1:7363 ROSA BELLE HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3346
Mailing Address - Country:US
Mailing Address - Phone:757-553-6947
Mailing Address - Fax:
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4082
Practice Address - Country:US
Practice Address - Phone:888-701-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006911225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist