Provider Demographics
NPI:1790286722
Name:BALLARD, LILLIAN R
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LILLIAN
Other - Middle Name:R
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 NW CLAY CT
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3696
Mailing Address - Country:US
Mailing Address - Phone:150-943-2359
Mailing Address - Fax:
Practice Address - Street 1:4822 E KENTUCKY AVE UNIT F
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2236
Practice Address - Country:US
Practice Address - Phone:509-432-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1871224Z00000X
WAOC60822605224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant