Provider Demographics
NPI:1376317313
Name:BLANDFORD, CALLIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ELIZABETH
Last Name:BLANDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 RICHLAND AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 RICHLAND AVE
Practice Address - Street 2:GROVER CENTER E187
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2745
Practice Address - Country:US
Practice Address - Phone:407-593-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist