Provider Demographics
NPI:1508168899
Name:BLACKBURN, AMY JILL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JILL
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EFFINGWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03882-8400
Mailing Address - Country:US
Mailing Address - Phone:603-301-1136
Mailing Address - Fax:
Practice Address - Street 1:30 COUNTY DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2900
Practice Address - Country:US
Practice Address - Phone:603-527-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist