Provider Demographics
NPI:1780331074
Name:BLAIR, KAREN LYNNE (OT/L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNNE
Other - Last Name:FRYSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:4654 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5402
Mailing Address - Country:US
Mailing Address - Phone:716-341-8401
Mailing Address - Fax:
Practice Address - Street 1:4654 LEWIS DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5402
Practice Address - Country:US
Practice Address - Phone:716-341-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7099225X00000X
FL22639225X00000X
NY013765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist