Provider Demographics
NPI:1053923029
Name:BALL, HEATHER (RBT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3005 SW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7902
Mailing Address - Country:US
Mailing Address - Phone:580-699-5558
Mailing Address - Fax:580-699-5559
Practice Address - Street 1:4084 REGENT DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1508
Practice Address - Country:US
Practice Address - Phone:940-228-5297
Practice Address - Fax:940-500-4025
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKRBT-19-96677106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKRBT-19-96677OtherBACB BOARD