MEDICARE: DAVID P BLEDSOE OTR

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	0514	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051534637	OTHER	AL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1538176839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID P BLEDSOE OTR

Provider Business Mailing Address
First Line	:	7088 UNIVERSITY CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-6992
Country	:	US
Telephone Number	:	334-396-1400
Fax Number	:	334-396-2727

Provider Business Practice Location Address
First Line	:	2090 COLUMBIANA RD
Second Line	:	1900
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2153
Country	:	US
Telephone Number	:	205-978-2358
Fax Number	:	205-978-2367

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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