Provider Demographics
NPI:1104063072
Name:BALLARD, ORA LAMAE
Entity type:Individual
Prefix:MRS
First Name:ORA
Middle Name:LAMAE
Last Name:BALLARD
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 1:6302 ROCKY NOOK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1331
Mailing Address - Country:US
Mailing Address - Phone:281-446-4134
Mailing Address - Fax:281-446-4134
Practice Address - Street 1:6302 ROCKY NOOK DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1331
Practice Address - Country:US
Practice Address - Phone:281-446-4134
Practice Address - Fax:281-446-4134
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities