Provider Demographics
NPI:1124051438
Name:BLEVINS, NICOLE L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 BOGLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2888
Mailing Address - Country:US
Mailing Address - Phone:606-679-1761
Mailing Address - Fax:606-678-0971
Practice Address - Street 1:353 BOGLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2888
Practice Address - Country:US
Practice Address - Phone:606-679-1761
Practice Address - Fax:606-678-0971
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKYR3456225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000371917OtherBCBS PROVIDER NUMBER
KY000000371917OtherBCBS PROVIDER NUMBER