Provider Demographics
NPI:1447968433
Name:BALLIE, KELLY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BALLIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LEAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4218
Mailing Address - Country:US
Mailing Address - Phone:434-944-1034
Mailing Address - Fax:
Practice Address - Street 1:1211 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1313
Practice Address - Country:US
Practice Address - Phone:336-275-0927
Practice Address - Fax:336-275-4834
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist