Healthcare Provider Details

I. General information

NPI: 1164116232
Provider Name (Legal Business Name): MADELINE BLUNIER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2500 WISCONSIN AVE NW APT 659
WASHINGTON DC
20007-4521
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3690
  • Fax:
Mailing address:
  • Phone: 309-256-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT210002204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: