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General NPI Number Information
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NPI Number | 1255144408
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Entity Type | Individual
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Provider Name | RORIE NICOLE BALLOUN
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 4727 W IRLO BRONSON MEMORIAL HWY
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City | KISSIMMEE
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State | FL
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Zip | 34746-5326
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Country | US
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Telephone | 321-972-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 185 FISH HAWK DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-4168
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Country | US
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Telephone | 863-289-6874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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