Provider Demographics
NPI:1265543904
Name:BLOSS, CARRIE J (OTR)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:J
Last Name:BLOSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 DORCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6476
Mailing Address - Country:US
Mailing Address - Phone:574-534-2548
Mailing Address - Fax:574-534-3622
Practice Address - Street 1:1824 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6476
Practice Address - Country:US
Practice Address - Phone:574-534-2548
Practice Address - Fax:574-534-3622
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003527A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN170200GMedicare ID - Type UnspecifiedOTR MEDICARE NUMBER