Healthcare Provider Details

I. General information

NPI: 1831419803
Provider Name (Legal Business Name): KRISTIN LYNN BLANK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 BOUNDARY ST STE 200
BEAUFORT SC
29902-6812
US

IV. Provider business mailing address

2682 BROAD ST
BEAUFORT SC
29902-6371
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-4778
  • Fax: 843-524-4779
Mailing address:
  • Phone: 717-404-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4418
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number4418
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: