Most Relevant Information
Provider Data
| NPI Number: | 1003478702 |
| Provider Name: | AUTUMN BALLARD COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/02/2019 |
| Last Updated: | 07/02/2019 |
Provider Practice Location
935 WAYNE RD
SAVANNAH
TN
383721904
Practice Location Phone/Fax
| Phone: | 7317278010 |
| Fax: |
Provider Mailing Location
65 SHANNON LN
COUNCE
TN
383262044
Provider Mailing Phone/Fax
| Phone: | 7314381140 |
| Fax: |