MEDICARE: ASHLEE NICHOLE BLANCHARD

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	225200000X	Physical Therapy Assistant	3494	OK

General Provider Information

NPI Number	:	1417676198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE NICHOLE BLANCHARD

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	726-202-3039
Fax Number	:

Provider Business Practice Location Address
First Line	:	11521 S WESTERN AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5883
Country	:	US
Telephone Number	:	405-809-8655
Fax Number	:

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	03/21/2025

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