Individual
NICOLE ASHLEY BALISTRERI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
S11W29667 SUMMIT AVE, WAUKESHA, WI 53188-9476
(262) 565-6124
Mailing address
8310 N ANDREA ST, MILWAUKEE, WI 53224-2768
(414) 526-4264
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6447-26
WI
Other
Enumeration date
07/08/2020
Last updated
07/27/2020
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