Provider Demographics
NPI:1770888604
Name:BALLOU, DEBRA RENEE (MOTR/L)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEE
Last Name:BALLOU
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 KELLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3423
Mailing Address - Country:US
Mailing Address - Phone:207-852-4037
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:41 KELLEY RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3423
Practice Address - Country:US
Practice Address - Phone:207-852-4037
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist