Active NPI
Cameron Balog, OTR
- Occupational Therapist
- Chicago, IL
National Provider Identifier
1124848007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.016241
- Practice address
- 6700 S Keating Ave
Chicago, IL 60629-5660 - Phone
- (773) 582-2888
- NPI assigned
- Oct 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.016241 | IL | Primary |
Addresses
Primary practice location
6700 S Keating Ave
Chicago, IL 60629-5660
Mailing address
1101 S State St Apt 1100
Chicago, IL 60605-3185
Phone (219) 308-4876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.016241 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728950400000",
"number": "1124848007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 S STATE ST APT 1100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606053185",
"telephone_number": "219-308-4876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6700 S KEATING AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606295660",
"telephone_number": "773-582-2888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALOG",
"first_name": "CAMERON",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-15",
"last_updated": "2024-10-15",
"certification_date": "2024-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.016241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.