Provider Demographics
NPI:1487761193
Name:BALL, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BALL
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 1:2117 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2513
Mailing Address - Country:US
Mailing Address - Phone:405-525-2484
Mailing Address - Fax:
Practice Address - Street 1:6729 NW 39TH EXPY
Practice Address - Street 2:SAWYER CENTER
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2605
Practice Address - Country:US
Practice Address - Phone:405-717-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1979OtherLICENSE #