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NPI Code Detail

MEDICARE: MRS. SHIRLEY S BALLARD OT

MEDICARE: MRS. SHIRLEY S BALLARD OT
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
1225X00000XOccupational Therapist0069AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151512913BALOTHERALBCBS

General Provider Information

NPI Number : 1588660070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHIRLEY S BALLARD OT
Provider Business Mailing Address
First Line : PO BOX 1200
Second Line :
City : CLANTON
State : AL
Zip : 35046-1200
Country : US
Telephone Number : 205-280-6450
Fax Number : 205-280-6451
Provider Business Practice Location Address
First Line : 110 BAKER AVE
Second Line :
City : CLANTON
State : AL
Zip : 35045-2337
Country : US
Telephone Number : 205-280-6450
Fax Number : 205-280-6451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. SHIRLEY S BALLARD OT” Practice Location

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