Provider Demographics
NPI:1043258080
Name:BLACHLY, KAY ELLEN (PT CHT)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:ELLEN
Last Name:BLACHLY
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4257
Mailing Address - Country:US
Mailing Address - Phone:503-540-6300
Mailing Address - Fax:503-540-6404
Practice Address - Street 1:5825 SHOREVIEW LN N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-540-6471
Practice Address - Fax:503-540-6404
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10211000232251H1200X
OR2199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand