Provider Demographics
NPI:1124287438
Name:BLANDFORD, SHANNON G (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:G
Last Name:BLANDFORD
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 1:2611 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4205
Mailing Address - Country:US
Mailing Address - Phone:270-978-1297
Mailing Address - Fax:
Practice Address - Street 1:2611 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4205
Practice Address - Country:US
Practice Address - Phone:270-978-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist