Basic Information
| Provider Information | |||||||||
| NPI: | 1487940771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALES | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | JOE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 S KEARNEY ST APT 115 | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802226459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654994969 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6060 E ILIFF AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037594221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 280887 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.