Provider Demographics
NPI:1700227659
Name:BLANKENSHIP, COLLEEN MICHELLE (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:SW RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1332
Mailing Address - Country:US
Mailing Address - Phone:954-829-1987
Mailing Address - Fax:
Practice Address - Street 1:5340 SW 188TH AVE
Practice Address - Street 2:
Practice Address - City:SW RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1332
Practice Address - Country:US
Practice Address - Phone:954-829-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist