Individual provider · NPI-1

Nicole Ashley Balistreri, MS, OTR/L

Occupational Therapist · Waukesha, WI

NPI number1700404597
StatusActive
Last updated in NPPESJul 27, 2020

Details

NPI
1700404597
Entity type
Individual (NPI-1)
Name
Nicole Ashley Balistreri
Credential
MS, OTR/L
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 8, 2020
Certification date
Jul 27, 2020
Last updated
Jul 27, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225X00000X Occupational Therapist6447-26WIYes

Practice location

S11w29667 Summit Ave
Waukesha, WI 53188-9476

Phone 262-565-6124

Mailing address

8310 N Andrea St
Milwaukee, WI 53224-2768

Phone 414-526-4264

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