Provider Demographics
NPI:1558634857
Name:BALLAGH, HEATHER (OT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BALLAGH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16815 S DESERT FOOTHILLS PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8401
Mailing Address - Country:US
Mailing Address - Phone:480-704-5954
Mailing Address - Fax:480-704-5807
Practice Address - Street 1:16815 S DESERT FOOTHILLS PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8401
Practice Address - Country:US
Practice Address - Phone:480-704-5954
Practice Address - Fax:480-704-5807
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0157-P225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist