Provider Demographics
NPI:1205341054
Name:BALL, AMY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:329438 E 1070 RD
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-9751
Mailing Address - Country:US
Mailing Address - Phone:580-704-2146
Mailing Address - Fax:
Practice Address - Street 1:6400 N SANTA FE AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist