Individual
MISS TANYA DAWN BALLENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
405 STANAFORD RD, BECKLEY, WV 25801-3143
(304) 252-6317
Mailing address
40 SMOKEY BRANCH RD, DANESE, WV 25831-7720
(304) 575-0927
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1512
WV
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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