Provider Demographics
NPI:1952517864
Name:BLICKLEY, KATHERINE PAYTON (OTR)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:PAYTON
Last Name:BLICKLEY
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 1:2108 INEZ DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4825
Mailing Address - Country:US
Mailing Address - Phone:505-450-9395
Mailing Address - Fax:505-291-2656
Practice Address - Street 1:2108 INEZ DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4825
Practice Address - Country:US
Practice Address - Phone:505-450-9395
Practice Address - Fax:505-291-2656
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist