Healthcare Provider Details

I. General information

NPI: 1508990888
Provider Name (Legal Business Name): MARY GERALDINE BALL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2009
US

IV. Provider business mailing address

PO BOX 2447
TUSCALOOSA AL
35403-2447
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-345-7341
Mailing address:
  • Phone: 850-932-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT4686
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number3203
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: