Provider Demographics
NPI:1760191324
Name:BLANC, JASON (OTR)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BLANC
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2408
Mailing Address - Country:US
Mailing Address - Phone:315-240-4313
Mailing Address - Fax:
Practice Address - Street 1:107 BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2408
Practice Address - Country:US
Practice Address - Phone:315-240-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist