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General NPI Number Information
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NPI Number | 1679055966
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Entity Type | Individual
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Provider Name | RYAN BLUE OTR
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Gender | Male
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 1213 WATER ST
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City | KERRVILLE
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State | TX
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Zip | 78028-3543
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Country | US
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Telephone | 830-896-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 135 OLD SAN ANTONIO RD # 8308
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City | BOERNE
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State | TX
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Zip | 78006-3415
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Country | US
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Telephone | 817-565-9373
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 118949
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License Number State | TX
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