Provider Demographics
NPI:1205378676
Name:BLANCHARD, JILL (OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ROOSEVELT RD
Mailing Address - Street 2:STE 200A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6269
Mailing Address - Country:US
Mailing Address - Phone:320-420-4080
Mailing Address - Fax:
Practice Address - Street 1:3315 ROOSEVELT RD
Practice Address - Street 2:STE 200A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6269
Practice Address - Country:US
Practice Address - Phone:320-420-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist