MEDICARE: MRS. LILLIAN R 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	224Z00000X	Occupational Therapy Assistant	OTA-1871	ID
2	224Z00000X	Occupational Therapy Assistant	OC60822605	WA
3	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1790286722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILLIAN R BALLARD

Provider Business Mailing Address
First Line	:	256 NW CLAY CT
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-3696
Country	:	US
Telephone Number	:	150-943-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	4822 E KENTUCKY AVE UNIT F
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-2236
Country	:	US
Telephone Number	:	509-432-3594
Fax Number	:

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

Provider Enumeration Date	:	02/25/2018
Last Update Date	:	09/30/2021

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Directions to “ MRS. LILLIAN R BALLARD ” Practice Location

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