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Individual

ELIZABETH DAKELMAN BALOG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
11690 NEELSVILLE CHURCH RD, GERMANTOWN, MD 20876-4127
(301) 353-0972
(301) 601-0381
Mailing address
11690 NEELSVILLE CHURCH RD, GERMANTOWN, MD 20876-4127
(301) 353-0972
(301) 601-0381

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
0062
MD
225X00000X
Occupational Therapist
Primary
03037
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03037
MD STATE BOARD OF OCCUPATIONAL THERY PRACTITIONERS
MD
Enumeration date
11/05/2018
Last updated
11/05/2018
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