Provider Demographics
NPI:1700254687
Name:BLY, BRITTANY (MS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9033
Mailing Address - Country:US
Mailing Address - Phone:804-771-9056
Mailing Address - Fax:
Practice Address - Street 1:1381 TREASURE LK
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-9033
Practice Address - Country:US
Practice Address - Phone:804-771-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-1656225X00000X
PAOC014760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist