Provider Demographics
NPI:1063098663
Name:BLOUNT, CHELSEA MARIE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S COUNTY ROAD 9
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-4060
Mailing Address - Country:US
Mailing Address - Phone:334-200-9047
Mailing Address - Fax:
Practice Address - Street 1:1100 S COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:SLOCOMB
Practice Address - State:AL
Practice Address - Zip Code:36375-4060
Practice Address - Country:US
Practice Address - Phone:334-200-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6375896343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)