Provider Demographics
NPI:1790976611
Name:BLANTON, VALERIE GAIL (COTA)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:GAIL
Last Name:BLANTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:GAIL
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1188 DYER STORE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-7821
Mailing Address - Country:US
Mailing Address - Phone:540-620-1008
Mailing Address - Fax:
Practice Address - Street 1:1188 DYER STORE RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-7821
Practice Address - Country:US
Practice Address - Phone:540-620-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 7248224Z00000X
VA0131000211224Z00000X
NC8465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant