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General NPI Number Information
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NPI Number | 1801508734
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Entity Type | Individual
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Provider Name | EMILY BALLARD OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 9130 S 52ND AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-1742
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Country | US
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Telephone | 708-423-1530
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Fax |
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Provider Business Mailing Address
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Address Line | 16106 CREEKMONT CT
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City | TINLEY PARK
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State | IL
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Zip | 60487-7565
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.015271
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License Number State | IL
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