Provider Demographics
NPI:1467664045
Name:STEWART, BLYTHE DECHELLY (OT)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:DECHELLY
Last Name:STEWART
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:DECHELLY
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2364 WILDOAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228
Mailing Address - Country:US
Mailing Address - Phone:214-498-2245
Mailing Address - Fax:
Practice Address - Street 1:2535 LONE STAR DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212
Practice Address - Country:US
Practice Address - Phone:214-467-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist