Healthcare Provider Details

I. General information

NPI: 1821723917
Provider Name (Legal Business Name): BALLARD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480H US 41 N STE 80
HENDERSON KY
42420-2359
US

IV. Provider business mailing address

4101 RODENBERG AVE
EVANSVILLE IN
47720-6230
US

V. Phone/Fax

Practice location:
  • Phone: 812-228-6896
  • Fax:
Mailing address:
  • Phone: 812-228-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KASIE BALLARD
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 812-228-6896