Provider Demographics
NPI:1174516058
Name:BALCH, DEBORAH JOHNSON (LOTR)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JOHNSON
Last Name:BALCH
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8537
Mailing Address - Country:US
Mailing Address - Phone:318-398-9675
Mailing Address - Fax:
Practice Address - Street 1:100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8537
Practice Address - Country:US
Practice Address - Phone:318-398-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist