1609071471 NPI number — MS. STEPHANIE LEIGH BLODGETT MS, OTR-L, CBIS

Table of content: MS. STEPHANIE LEIGH BLODGETT MS, OTR-L, CBIS (NPI 1609071471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609071471 NPI number — MS. STEPHANIE LEIGH BLODGETT MS, OTR-L, CBIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLODGETT
Provider First Name:
STEPHANIE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR-L, CBIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609071471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 BELMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HALEDON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07508-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-478-4200
Provider Business Mailing Address Fax Number:
201-478-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18-01 POLLITT DR
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-478-4200
Provider Business Practice Location Address Fax Number:
201-478-4201
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  46TR00351900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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