Provider Demographics
NPI:1932413184
Name:BALLEW, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
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 1:3833 S TEXAS AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4039
Mailing Address - Country:US
Mailing Address - Phone:979-220-9406
Mailing Address - Fax:
Practice Address - Street 1:3833 S TEXAS AVE
Practice Address - Street 2:STE 111
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4039
Practice Address - Country:US
Practice Address - Phone:979-220-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist