Provider Demographics
NPI:1639302037
Name:WEST, BLAINE N (LO CO LPA)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:N
Last Name:WEST
Suffix:
Gender:M
Credentials:LO CO LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 N LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2529
Mailing Address - Country:US
Mailing Address - Phone:903-983-5696
Mailing Address - Fax:
Practice Address - Street 1:3737 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2529
Practice Address - Country:US
Practice Address - Phone:903-983-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180222Z00000X
OK28222Z00000X
TX1148225000000X
OK9225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter