Provider Demographics
NPI:1154283042
Name:RUDMANN, BLAISE E (OTR)
Entity type:Individual
Prefix:MR
First Name:BLAISE
Middle Name:E
Last Name:RUDMANN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17159 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4638
Mailing Address - Country:US
Mailing Address - Phone:440-318-4765
Mailing Address - Fax:
Practice Address - Street 1:11900 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1062
Practice Address - Country:US
Practice Address - Phone:216-983-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-29
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist