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General NPI Number Information
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NPI Number | 1801219209
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Entity Type | Individual
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Provider Name | MICHELLE ANN BALLARD OTR
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Gender | Female
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 2564 FOXPOINTE DRIVE KEEPSAKE VILLAGE
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City | COLUMBUS
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State | IN
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Zip | 47203
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Country | US
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Telephone | 812-375-8869
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Fax | 812-375-8871
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Provider Business Mailing Address
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Address Line | 140 E STEINKAMP ST
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City | BROWNSTOWN
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State | IN
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Zip | 47220-1949
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Country | US
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Telephone | 812-216-3676
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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 | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 31001109A
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License Number State | IN
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