Provider Demographics
NPI:1427178615
Name:BLANTON, KIMBERLY STEWART (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:STEWART
Last Name:BLANTON
Suffix:
Gender:F
Credentials:OTRL
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 53
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-0053
Mailing Address - Country:US
Mailing Address - Phone:405-872-5995
Mailing Address - Fax:
Practice Address - Street 1:312 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068
Practice Address - Country:US
Practice Address - Phone:405-872-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT66225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist