Provider Demographics
NPI:1538292099
Name:BLATCHFORD, ANDREA RHIANNON (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RHIANNON
Last Name:BLATCHFORD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4837
Mailing Address - Country:US
Mailing Address - Phone:843-442-1168
Mailing Address - Fax:
Practice Address - Street 1:1885 RIFLE RANGE RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9440
Practice Address - Country:US
Practice Address - Phone:843-856-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2444224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant