Provider Demographics
NPI:1275873564
Name:BLACKWELL, CYNTHIA LYNN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 3RD AVE N
Mailing Address - Street 2:APT 313
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2882
Mailing Address - Country:US
Mailing Address - Phone:708-612-4174
Mailing Address - Fax:
Practice Address - Street 1:1100 3RD AVE N
Practice Address - Street 2:APT 313
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2882
Practice Address - Country:US
Practice Address - Phone:708-612-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-009866225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics