Provider Demographics
NPI:1356013981
Name:BALLARD, JOSEY DESLYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOSEY
Middle Name:DESLYNN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JOSEY
Other - Middle Name:DESLYNN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:104 N MAIN
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669
Mailing Address - Country:US
Mailing Address - Phone:580-661-3517
Mailing Address - Fax:
Practice Address - Street 1:118 E BROADWAY
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669
Practice Address - Country:US
Practice Address - Phone:580-661-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant