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General NPI Number Information
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NPI Number | 1730315995
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Entity Type | Individual
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Provider Name | CARMEN ELYSE BLATNICK DPT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1005 S COUNTRY CLUB RD
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City | STILLWATER
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State | OK
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Zip | 74074-1430
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Country | US
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Telephone | 517-575-5493
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Fax | 405-212-5175
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Provider Business Mailing Address
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Address Line | 1005 S COUNTRY CLUB RD
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City | STILLWATER
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State | OK
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Zip | 74074-1430
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Country | US
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Telephone | 517-575-5493
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Fax | 405-212-5175
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1186757
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State | TX
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