Provider Demographics
NPI:1659619039
Name:BLAGDON, AUDREY FRANCES AVERILL (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:FRANCES AVERILL
Last Name:BLAGDON
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W ALNA RD
Mailing Address - Street 2:
Mailing Address - City:ALNA
Mailing Address - State:ME
Mailing Address - Zip Code:04535-3828
Mailing Address - Country:US
Mailing Address - Phone:207-350-1093
Mailing Address - Fax:
Practice Address - Street 1:191 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4207
Practice Address - Country:US
Practice Address - Phone:207-273-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO2719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist