Provider Demographics
NPI:1245502343
Name:BLAIR, JENNIFER LYNN (OTR/L, BCP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16230 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:DARNESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3206
Mailing Address - Country:US
Mailing Address - Phone:860-209-9183
Mailing Address - Fax:
Practice Address - Street 1:16230 BELLINGHAM DR
Practice Address - Street 2:
Practice Address - City:DARNESTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3206
Practice Address - Country:US
Practice Address - Phone:860-209-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC010000805225XP0200X
MD06942225XP0200X
VA0119005678225XP0200X
CT002902225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics