Meredith Ballard, OTR/L

Key facts

NPI

1720554223

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

License

4287 (CT)

Practice address

163 Quinnipiac Ave
North Haven, CT 06473-3623

Phone

(203) 624-3303

NPI assigned

Oct 23, 2018

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 23, 2018.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1720554223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 QUINNIPIAC AVE",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064733623",
            "telephone_number": "203-624-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 QUINNIPIAC AVE",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064733623",
            "telephone_number": "203-624-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "MEREDITH",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "4287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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