Provider Demographics
NPI:1609071471
Name:BLODGETT, STEPHANIE LEIGH (MS, OTR-L, CBIS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:MS, OTR-L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2309
Mailing Address - Country:US
Mailing Address - Phone:201-478-4200
Mailing Address - Fax:201-478-4201
Practice Address - Street 1:18-01 POLLITT DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2813
Practice Address - Country:US
Practice Address - Phone:201-478-4200
Practice Address - Fax:201-478-4201
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00351900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist