MEDICARE: PAULA A. BLANKENBURG OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1279	NC

General Provider Information

NPI Number	:	1184749459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA A. BLANKENBURG OT

Provider Business Mailing Address
First Line	:	17347 MEADOW BOTTOM RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6588
Country	:	US
Telephone Number	:	704-780-8901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209
Country	:	US
Telephone Number	:	704-527-4343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/10/2015

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