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NPI Code Detail

MEDICARE: MRS. RUTH A BLAMEUSER M.S. OT, OTR/L

MEDICARE: MRS. RUTH A BLAMEUSER M.S. OT, 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 Therapist056003840IL
2225XP0200XPediatric Occupational Therapist056003840IL

General Provider Information

NPI Number : 1831479187
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RUTH A BLAMEUSER M.S. OT, OTR/L
Provider Business Mailing Address
First Line : 4701 N OAK ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60012-3309
Country : US
Telephone Number : 847-609-9366
Fax Number : 815-788-1422
Provider Business Practice Location Address
First Line : 4701 N OAK ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60012-3309
Country : US
Telephone Number : 815-788-1020
Fax Number : 815-788-1422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2011
Last Update Date : 08/18/2011

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