Provider Demographics
NPI:1083959001
Name:BALLARD, CALEB SANDERS (MOT, OTR/L, CEAS I)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:SANDERS
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MOT, OTR/L, CEAS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 CALLIOPE WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6064
Mailing Address - Country:US
Mailing Address - Phone:270-556-3441
Mailing Address - Fax:
Practice Address - Street 1:2300 WESTINGHOUSE BLVD
Practice Address - Street 2:107
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2493
Practice Address - Country:US
Practice Address - Phone:919-256-1400
Practice Address - Fax:919-256-1403
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist