Healthcare Provider Details

I. General information

NPI: 1023272374
Provider Name (Legal Business Name): MARIA ANN BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MCKNIGHT AVE.
WEST FORK AR
72774-0000
US

IV. Provider business mailing address

322 KELLI AVE
FARMINGTON AR
72730-2603
US

V. Phone/Fax

Practice location:
  • Phone: 479-839-3035
  • Fax:
Mailing address:
  • Phone: 479-839-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR 2190
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: