Provider Demographics
NPI:1770756090
Name:BALANCE OT, INC
Entity type:Organization
Organization Name:BALANCE OT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:206-508-1265
Mailing Address - Street 1:3323 NW 71ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-6146
Mailing Address - Country:US
Mailing Address - Phone:206-508-1265
Mailing Address - Fax:206-508-1265
Practice Address - Street 1:2821 NW MARKET ST STE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5815
Practice Address - Country:US
Practice Address - Phone:206-508-1265
Practice Address - Fax:206-508-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001887261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4020-CLOtherREGENCE
WA0207147OtherLABOR AND INDUSTRIES-WA