Provider Demographics
NPI:1134331705
Name:BALL, SUSAN A (COTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ASCUE ROAD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609
Mailing Address - Country:US
Mailing Address - Phone:276-596-9448
Mailing Address - Fax:
Practice Address - Street 1:WESTWOOD CENTER
Practice Address - Street 2:WESTWOOD MEDICAL PARE
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant