Priscilla Balderas, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

4264026 Issued in WI

Practice address

3212 W Mount Vernon Ave
Milwaukee, WI 53208-4130

Phone

(414) 763-6938

NPI assigned

Apr 23, 2008

Last updated

Nov 16, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• NSH Mercy LLC

  • Skilled Nursing Facility
  • Milwaukee, WI
  • NPI 1134647928
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1366617268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "414-228-8700",
            "fax_number": "262-577-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 W MOUNT VERNON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532084130",
            "telephone_number": "414-763-6938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDERAS",
        "first_name": "PRISCILLA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "4264026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40897300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Balanced Mental Health and Wellness LLC
• Gokulakrishnan Balasubramanian, M.D.
• Constance Marilyn Balcom, APSW
• Danielle Marie Bald, APSW, MSW
• Katie Jane Balderas, PA-C
• Angel Danielle Baldwin, RN
• Antoinette Baldwin
• Grant Bales, MD
• Travis Ryan Bales, MD
• Linda Marie Balfanz, OTR

• Occupational Therapist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.