Provider Demographics
NPI:1982011029
Name:BALLARD, CATRICE J (MS, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:CATRICE
Middle Name:J
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 ADKINS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1103
Mailing Address - Country:US
Mailing Address - Phone:301-367-6132
Mailing Address - Fax:
Practice Address - Street 1:14101 ADKINS RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1103
Practice Address - Country:US
Practice Address - Phone:301-367-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer