Provider Demographics
NPI:1639525140
Name:BALLEW, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BALLEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0020
Mailing Address - Country:US
Mailing Address - Phone:541-488-3262
Mailing Address - Fax:
Practice Address - Street 1:295 E MAIN
Practice Address - Street 2:SUITE 10
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-0020
Practice Address - Country:US
Practice Address - Phone:541-488-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-541784246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other