Provider Demographics
NPI:1215297205
Name:BLANN, NAN MARILYN (OT)
Entity type:Individual
Prefix:MRS
First Name:NAN
Middle Name:MARILYN
Last Name:BLANN
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 1:38 WALNUT PL
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1601
Mailing Address - Country:US
Mailing Address - Phone:908-675-6853
Mailing Address - Fax:
Practice Address - Street 1:1701 KNEELEY BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7622
Practice Address - Country:US
Practice Address - Phone:732-493-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00099500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist