MEDICARE: JOHN H BALL

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	225X00000X	Occupational Therapist	004219-1	NY

General Provider Information

NPI Number	:	1578728887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H BALL

Provider Business Mailing Address
First Line	:	3027 LOVERS LN
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891-9716
Country	:	US
Telephone Number	:	607-228-7631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3027 LOVERS LN
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891-9716
Country	:	US
Telephone Number	:	607-228-7631
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	04/30/2014

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Directions to “ JOHN H BALL ” Practice Location

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