Provider Demographics
NPI:1366670283
Name:BLANCHARD, KERETH LYNN (OT)
Entity Type:Individual
Prefix:
First Name:KERETH
Middle Name:LYNN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KERETH
Other - Middle Name:LYNN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2 DUDLEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:401-457-1580
Mailing Address - Fax:401-831-0500
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:401-457-1580
Practice Address - Fax:401-831-0500
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOT00942OtherSTATE LICENSE NUMBER