Provider Demographics
NPI:1588660070
Name:BALLARD, SHIRLEY S (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:S
Last Name:BALLARD
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:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046-1200
Mailing Address - Country:US
Mailing Address - Phone:205-280-6450
Mailing Address - Fax:205-280-6451
Practice Address - Street 1:110 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2337
Practice Address - Country:US
Practice Address - Phone:205-280-6450
Practice Address - Fax:205-280-6451
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51512913BALOtherBCBS
AL016587Medicare ID - Type Unspecified
AL51512913BALOtherBCBS