Provider Demographics
NPI:1790957785
Name:BLYTHE, KAREN M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:HUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2004 OAK LEAF LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-2309
Mailing Address - Fax:
Practice Address - Street 1:2004 OAK LEAF LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2526
Practice Address - Country:US
Practice Address - Phone:757-460-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1029953224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1029953OtherNBCOT