Provider Demographics
NPI:1336659812
Name:BLEVINS, JEAN ATLAS (OTR)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ATLAS
Last Name:BLEVINS
Suffix:
Gender:F
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0840
Mailing Address - Country:US
Mailing Address - Phone:845-820-2959
Mailing Address - Fax:
Practice Address - Street 1:31 KINNEBROOK RD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist