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General NPI Number Information
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NPI Number | 1154724045
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Entity Type | Individual
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Provider Name | JESSICA BLACKMAN
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Gender | Female
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 734 W 19TH ST
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City | CASPER
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State | WY
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Zip | 82601-4520
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Country | US
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Telephone | 307-267-5549
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Fax |
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Provider Business Mailing Address
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Address Line | 734 W 19TH ST
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City | CASPER
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State | WY
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Zip | 82601-4520
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Country | US
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Telephone | 307-267-5549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 831
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0007595
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1670
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License Number State | WY
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