Provider Demographics
NPI:1154043230
Name:BALLINGER, SARAH JORDAN (COTA/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JORDAN
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BRANTLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-7585
Mailing Address - Country:US
Mailing Address - Phone:662-931-3221
Mailing Address - Fax:
Practice Address - Street 1:112 BRANTLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-7585
Practice Address - Country:US
Practice Address - Phone:662-931-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant