Healthcare Provider Details

I. General information

NPI: 1831930353
Provider Name (Legal Business Name): ADRIENNE BLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 W 90TH AVE APT 104
MERRILLVILLE IN
46410-6750
US

IV. Provider business mailing address

1359 W 90TH AVE APT 104
MERRILLVILLE IN
46410-6750
US

V. Phone/Fax

Practice location:
  • Phone: 708-573-8081
  • Fax:
Mailing address:
  • Phone: 708-573-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32003809A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: