Provider Demographics
NPI:1750862090
Name:BLONDIN, CARLY JO (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:JO
Last Name:BLONDIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:JO
Other - Last Name:SALFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6005 AQUA BLUE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7208
Mailing Address - Country:US
Mailing Address - Phone:507-829-3769
Mailing Address - Fax:
Practice Address - Street 1:901 N JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1603
Practice Address - Country:US
Practice Address - Phone:702-648-3425
Practice Address - Fax:702-648-1408
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist