Provider Demographics
NPI:1053936385
Name:BALTENBERGER, REBECCA J (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BALTENBERGER
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BLUFFTON CIR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4325
Mailing Address - Country:US
Mailing Address - Phone:229-894-4207
Mailing Address - Fax:
Practice Address - Street 1:2 GRIFFITH RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3503
Practice Address - Country:US
Practice Address - Phone:855-525-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist