Provider Demographics
NPI:1154488823
Name:BLOTTER, JAMES GREG (OTR)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GREG
Last Name:BLOTTER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 500 E STE 130
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2466
Mailing Address - Country:US
Mailing Address - Phone:435-716-2880
Mailing Address - Fax:
Practice Address - Street 1:1300 N 500 E STE 130
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2466
Practice Address - Country:US
Practice Address - Phone:435-716-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107090-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist