Provider Demographics
NPI:1275648883
Name:BLUM, ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BLUM
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 1:4923 US ROUTE 5
Mailing Address - Street 2:SOJOURNS COMMUNITY HEALTH CLINIC
Mailing Address - City:WESTMINSTER
Mailing Address - State:VT
Mailing Address - Zip Code:05158-9651
Mailing Address - Country:US
Mailing Address - Phone:802-722-4023
Mailing Address - Fax:802-722-4137
Practice Address - Street 1:4923 US ROUTE 5
Practice Address - Street 2:SOJOURNS COMMUNITY HEALTH CLINIC
Practice Address - City:WESTMINSTER
Practice Address - State:VT
Practice Address - Zip Code:05158-9651
Practice Address - Country:US
Practice Address - Phone:802-722-4023
Practice Address - Fax:802-722-4137
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59085OtherBCBS
791462OtherMVP
VTOVN2961Medicaid
791462OtherMVP