Provider Demographics
NPI:1245368091
Name:BALL, JENNIFER A (OTR L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BALL
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:2128 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1910
Mailing Address - Country:US
Mailing Address - Phone:716-874-4500
Mailing Address - Fax:716-874-3195
Practice Address - Street 1:2128 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:716-874-4500
Practice Address - Fax:716-874-3195
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465154Medicaid