MEDICARE: TERRY LEE BLANKENSHIP HCHI,HCD,CMT,CD(DONA

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	374J00000X	Doula	374J00000X	IN

General Provider Information

NPI Number	:	1477888931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY LEE BLANKENSHIP HCHI,HCD,CMT,CD(DONA

Provider Business Mailing Address
First Line	:	43 S KITLEY AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-6711
Country	:	US
Telephone Number	:	317-414-4095
Fax Number	:

Provider Business Practice Location Address
First Line	:	6512 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-6633
Country	:	US
Telephone Number	:	317-322-1300
Fax Number	:

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

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	10/16/2009

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