Provider Demographics
NPI:1417225459
Name:BLUNTE, KERRON (OT)
Entity Type:Individual
Prefix:
First Name:KERRON
Middle Name:
Last Name:BLUNTE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 F ST NW STE 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2761
Mailing Address - Country:US
Mailing Address - Phone:202-912-8480
Mailing Address - Fax:202-912-8484
Practice Address - Street 1:2112 F ST NW STE 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2761
Practice Address - Country:US
Practice Address - Phone:202-912-8480
Practice Address - Fax:202-912-8484
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT210002137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist