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General NPI Number Information
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NPI Number | 1902223274
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Entity Type | Individual
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Provider Name | KATHI MARIE BALLARD OTA
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 933 CEDAR RD
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City | CHESAPEAKE
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State | VA
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Zip | 23322-7415
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Country | US
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Telephone | 757-941-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 532 DEER NECK DR
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City | CHESAPEAKE
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State | VA
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Zip | 23323-7102
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Country | US
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Telephone | 757-582-4270
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0131001238
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License Number State | VA
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