Provider Demographics
NPI:1477884013
Name:BLANKENSHIP CLARK, ASHLI BETH (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:ASHLI
Middle Name:BETH
Last Name:BLANKENSHIP CLARK
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 CELINE RD
Mailing Address - Street 2:
Mailing Address - City:BIRDSEYE
Mailing Address - State:IN
Mailing Address - Zip Code:47513-9004
Mailing Address - Country:US
Mailing Address - Phone:812-357-5557
Mailing Address - Fax:
Practice Address - Street 1:800 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2514
Practice Address - Country:US
Practice Address - Phone:812-996-0682
Practice Address - Fax:812-996-0268
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003558A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist