Provider Demographics
NPI:1154800738
Name:BLACKWELL, ANN ODWYER (OT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ODWYER
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MOUNTAIN VIEW AVE SE
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-3320
Mailing Address - Country:US
Mailing Address - Phone:828-390-5004
Mailing Address - Fax:
Practice Address - Street 1:107 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4505
Practice Address - Country:US
Practice Address - Phone:828-390-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3845225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist