Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003478702 |
---|---|
Provider Name | Autumn Ballard |
First Address | Counce, TN 38326-2044 |
Second Address | Savannah, TN 38372-1904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |