# BALANCED LIFE THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700420411
- **Authorized official:** MALLORY IRVIN MS OTR (OWNER)
- **Authorized official phone:** (812) 316-0072

## Contact information

- **Practice address:** 1813 WILLOW ST STE 1B, VINCENNES, IN 47591-4279
- **Practice address phone:** (812) 316-0072
- **Mailing address:** 1813 WILLOW ST STE 1B, VINCENNES, IN 47591-4279

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2019
- **Last updated:** 05/13/2022