Basic Information
| Provider Information | |||||||||
| NPI: | 1396991246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALILI | ||||||||
| FirstName: | MARI DEAN | ||||||||
| MiddleName: | ROSALES | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2035 W CHARLESTON BLVD | ||||||||
| Address2: | ST. JOSEPH TRANSITIONAL REHABILITATION CENTER | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023867980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2035 W CHARLESTON BLVD | ||||||||
| Address2: | ST. JOSEPH TRANSITIONAL REHABILITATION CENTER | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023867980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0791 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.