Provider Demographics
NPI:1992096598
Name:BALUK, CRYSTAL ANNE (MOTR/L)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:ANNE
Last Name:BALUK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:1710 ROUTE 114
Mailing Address - City:NORTH SUTTON
Mailing Address - State:NH
Mailing Address - Zip Code:03260
Mailing Address - Country:US
Mailing Address - Phone:603-927-4251
Mailing Address - Fax:
Practice Address - Street 1:24 OLD ETNA RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1937
Practice Address - Country:US
Practice Address - Phone:603-927-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist