Provider Demographics
NPI:1508990888
Name:BALL, MARY GERALDINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GERALDINE
Last Name:BALL
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:PO BOX 2447
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2447
Mailing Address - Country:US
Mailing Address - Phone:850-932-9393
Mailing Address - Fax:
Practice Address - Street 1:400 PAUL W BRYANT DR E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2009
Practice Address - Country:US
Practice Address - Phone:205-345-0192
Practice Address - Fax:205-345-7341
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4686225XH1200X
AL3203225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-02180OtherBCBS
AL206106Medicaid