Individual
MRS. CONSTANCE P BALLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L CHT
Contact information
Practice address
11126 NE 104TH WAY, KIRKLAND, WA 98033-5034
(425) 827-9594
Mailing address
12910 TOTEM LAKE BLVD NE, SUITE 130, KIRKLAND, WA 98034-2954
(888) 924-2631
(425) 924-2630
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT00002332
WA
225XH1200X
Hand Occupational Therapist
Primary
9105000876
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115763
L AND I
WA
05
—
7680697
—
WA
01
—
BA5492
REGENCE
WA
Enumeration date
03/05/2007
Last updated
10/26/2010
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