MEDICARE: MS. ANTONIA BALLARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	122-29-30	OH

General Provider Information

NPI Number	:	1134935869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANTONIA BALLARD

Provider Business Mailing Address
First Line	:	3720 WILLOW RUN DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-2647
Country	:	US
Telephone Number	:	567-225-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 WILLOW RUN DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-2647
Country	:	US
Telephone Number	:	567-225-0512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	12/07/2024

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Directions to “ MS. ANTONIA BALLARD ” Practice Location

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