Provider Demographics
NPI:1356078331
Name:BALL, MEGAN MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:BALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LOU AMBERS DR
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1568
Mailing Address - Country:US
Mailing Address - Phone:315-360-2288
Mailing Address - Fax:
Practice Address - Street 1:690 W GERMAN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2198
Practice Address - Country:US
Practice Address - Phone:315-866-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist