Provider Demographics
NPI:1194800193
Name:BLAYLOCK, JANET W (MOT, CHT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:W
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:MOT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5413
Mailing Address - Country:US
Mailing Address - Phone:302-655-9494
Mailing Address - Fax:302-691-1478
Practice Address - Street 1:550 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2198
Practice Address - Country:US
Practice Address - Phone:302-691-5603
Practice Address - Fax:302-691-5623
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000043225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3767397000OtherIBC
DEP00885362OtherRAILROAD MEDICARE
DE2783018OtherHIGHMARK
MD4586026Medicaid
DE1194800193Medicaid
DEAC44-0033OtherCAREFIRST
DEP00885362OtherRAILROAD MEDICARE
DE131991ZB82Medicare PIN