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General NPI Number Information
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NPI Number | 1356023972
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Entity Type | Individual
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Provider Name | TIMOTHY RYAN BLANTON
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Gender | Male
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 100 ENGLAND ST FL 2
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City | ASHLAND
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State | VA
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Zip | 23005-2013
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Country | US
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Telephone | 804-368-8475
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Fax |
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Provider Business Mailing Address
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Address Line | 11200 TISBERRY LN
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City | ASHLAND
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State | VA
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Zip | 23005-7731
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Country | US
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Telephone |
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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 | 0131002457
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License Number State | VA
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