Provider Demographics
NPI:1275699647
Name:BLAIR, NANCY (OT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:OT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3509
Mailing Address - Country:US
Mailing Address - Phone:207-283-1954
Mailing Address - Fax:207-283-1954
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3509
Practice Address - Country:US
Practice Address - Phone:207-283-1954
Practice Address - Fax:207-283-1954
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1520224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant