Provider Demographics
NPI:1508534439
Name:BLAIR, JENNY ANN (MOT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANN
Other - Last Name:BALFOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:327 ROCK CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4715
Mailing Address - Country:US
Mailing Address - Phone:916-759-2704
Mailing Address - Fax:
Practice Address - Street 1:144 CONTINENTE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1999
Practice Address - Country:US
Practice Address - Phone:925-513-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty