Provider Demographics
NPI:1578024709
Name:BLANDFORD, ALFREDA FURSTENBERG (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALFREDA
Middle Name:FURSTENBERG
Last Name:BLANDFORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WESTERN BLVD # 27886
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-4017
Mailing Address - Country:US
Mailing Address - Phone:252-823-0401
Mailing Address - Fax:
Practice Address - Street 1:1000 WESTERN BLVD # 27886
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4017
Practice Address - Country:US
Practice Address - Phone:252-823-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4574224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant