Provider Demographics
NPI:1558081737
Name:BLAIR, KIRSTYN NICOLE (KIRSTYN BLAIR COTA/L)
Entity Type:Individual
Prefix:
First Name:KIRSTYN
Middle Name:NICOLE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:KIRSTYN BLAIR COTA/L
Other - Prefix:
Other - First Name:KIRSTYN
Other - Middle Name:NICOLE
Other - Last Name:ECKLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1078 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9030
Mailing Address - Country:US
Mailing Address - Phone:440-855-7719
Mailing Address - Fax:
Practice Address - Street 1:1078 GARRISON RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9030
Practice Address - Country:US
Practice Address - Phone:440-855-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007785224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant