Provider Demographics
NPI:1568612109
Name:BLYTHE, DEIDRE (PT)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:IN
Mailing Address - Zip Code:47631-9075
Mailing Address - Country:US
Mailing Address - Phone:812-682-4104
Mailing Address - Fax:812-682-4522
Practice Address - Street 1:251 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-9075
Practice Address - Country:US
Practice Address - Phone:812-682-4104
Practice Address - Fax:812-682-4522
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004517A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist