Individual
PRISCILLA BALDERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3212 W MOUNT VERNON AVE, MILWAUKEE, WI 53208-4130
(414) 763-6938
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(414) 228-8700
(262) 577-0226
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4264026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40897300
—
WI
Enumeration date
04/23/2008
Last updated
11/16/2016
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