Provider Demographics
NPI:1619228772
Name:BALLARD, KASIE A (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KASIE
Middle Name:A
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KASIE
Other - Middle Name:A
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 RODENBERG AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-6230
Mailing Address - Country:US
Mailing Address - Phone:812-228-6896
Mailing Address - Fax:
Practice Address - Street 1:4101 RODENBERG AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-6230
Practice Address - Country:US
Practice Address - Phone:812-228-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264002225X00000X
225XP0200X
IN31005330A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics