Provider Demographics
NPI:1477690972
Name:BLANCHARD, IRENE MARY (OTR)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARY
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 YALE PL
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2834
Mailing Address - Country:US
Mailing Address - Phone:516-536-9474
Mailing Address - Fax:
Practice Address - Street 1:19 YALE PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2834
Practice Address - Country:US
Practice Address - Phone:516-536-9474
Practice Address - Fax:516-536-5491
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001739-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist