Basic Information
| Provider Information | |||||||||
| NPI: | 1871941278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | SHABORAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 FAIRWAY DR STE 102 | ||||||||
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| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334411817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 780 LYNNHAVEN PKWY STE 400 | ||||||||
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| City: | VA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234527332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.