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NPI Code Detail

MEDICARE: DR. CARLY JO BLONDIN OTD, OTR/L

MEDICARE: DR. CARLY JO BLONDIN OTD, OTR/L
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
1225X00000XOccupational TherapistOT-2078NV

General Provider Information

NPI Number : 1750862090
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLY JO BLONDIN OTD, OTR/L
Provider Business Mailing Address
First Line : 6005 AQUA BLUE CT
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-7208
Country : US
Telephone Number : 507-829-3769
Fax Number :
Provider Business Practice Location Address
First Line : 901 N JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-1603
Country : US
Telephone Number : 702-648-3425
Fax Number : 702-648-1408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2018
Last Update Date : 08/24/2018

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