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NPI Code Detail

MEDICARE: JENESSA RENEA BLEW

MEDICARE:   JENESSA RENEA BLEW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant18-00998KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118-00998OTHERKSKANSAS BOARD OF HEALING ARTS

General Provider Information

NPI Number : 1689130676
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENESSA RENEA BLEW
Provider Business Mailing Address
First Line : 9515 W PLEASANT VALLEY RD
Second Line :
City : PARTRIDGE
State : KS
Zip : 67566-9041
Country : US
Telephone Number : 620-899-0315
Fax Number :
Provider Business Practice Location Address
First Line : 1701 E 23RD AVE
Second Line :
City : HUTCHINSON
State : KS
Zip : 67502-1105
Country : US
Telephone Number : 620-665-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2019
Last Update Date : 02/14/2019

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Directions to “ JENESSA RENEA BLEW ” Practice Location

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