Individual
EYERUSALEM A BALAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1290 CRESTCOVE DR, ROCKWALL, TX 75087-3172
(615) 589-6175
Mailing address
1290 CRESTCOVE DR, ROCKWALL, TX 75087-3172
(615) 589-6175
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214342
TX
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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