Provider Demographics
NPI:1902223274
Name:BALLARD, KATHI MARIE (OTA)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:MARIE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 DEER NECK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-7102
Mailing Address - Country:US
Mailing Address - Phone:757-582-4270
Mailing Address - Fax:
Practice Address - Street 1:933 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7415
Practice Address - Country:US
Practice Address - Phone:757-941-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001238224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant