Provider Demographics
NPI:1457850547
Name:BLENDEN, GABRIELLE A (OT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:A
Last Name:BLENDEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4444 FOREST PARK AVE
Mailing Address - Street 2:MSC 8505-66-01
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2212
Mailing Address - Country:US
Mailing Address - Phone:314-286-1669
Mailing Address - Fax:314-286-1601
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:DEPT OCCUPATIONAL THERAPY, STE 2210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1669
Practice Address - Fax:314-289-6131
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-08-30
Deactivation Date:2018-09-04
Deactivation Code:
Reactivation Date:2018-10-31
Provider Licenses
StateLicense IDTaxonomies
MO2018005942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist