Provider Demographics
NPI:1063697969
Name:BLEVINS, ANN MARIE (MHSOTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MHSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 TALL PINES RD
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3106
Mailing Address - Country:US
Mailing Address - Phone:843-376-3603
Mailing Address - Fax:
Practice Address - Street 1:223 TALL PINES RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3106
Practice Address - Country:US
Practice Address - Phone:843-376-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist