Provider Demographics
NPI:1477616852
Name:SBLENDORIO, MICHAEL E (OT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:SBLENDORIO
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 1:422 LONG LEAF ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4016
Mailing Address - Country:US
Mailing Address - Phone:910-452-4704
Mailing Address - Fax:910-256-8560
Practice Address - Street 1:530 CAUSEWAY DR
Practice Address - Street 2:SUITE B-3
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1959
Practice Address - Country:US
Practice Address - Phone:910-509-2810
Practice Address - Fax:910-256-8560
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2511209Medicare ID - Type UnspecifiedPART B