Provider Demographics
NPI:1346227501
Name:BALLENGER, JO ELLEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:ELLEN
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 S EAST ST
Mailing Address - Street 2:BUILDING D SUITE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1917
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3745
Practice Address - Street 1:5214 S EAST ST
Practice Address - Street 2:BUILDING D SUITE 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1917
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002655A225X00000X
OHOT-04449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist