NPIMap

Organization Active NPI

Balanced Life Therapy

  • Occupational Therapist
  • Vincennes, IN
National Provider Identifier
1700420411
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
BALANCED LIFE THERAPY
Practice address
1813 Willow St Ste 1B
Vincennes, IN 47591-4279
Phone
(812) 316-0072
NPI assigned
Nov 5, 2019
Last updated
May 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Authorized official

Name
Mallory Irvin, MS OTRNPI 1720531437
Title
Owner
Phone
(812) 316-0072

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

1813 Willow St Ste 1B
Vincennes, IN 47591-4279

Mailing address

1813 Willow St Ste 1B
Vincennes, IN 47591-4279

National Provider Directory

National Provider Directory

Locations

1813 Willow St
Ste 1B
Vincennes, IN 47591
Phone (812) 316-0072

1813 Willow St
Ste 4D
Vincennes, IN 47591
Phone (812) 316-0072

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1700420411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 WILLOW ST STE 1B",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 WILLOW ST STE 1B",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914279",
            "telephone_number": "812-316-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED LIFE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A",
        "authorized_official_last_name": "IRVIN",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-316-0072",
        "authorized_official_credential": "MS OTR"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.