Provider Demographics
NPI:1285810622
Name:BAIN, BLAIR E
Entity type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:E
Last Name:BAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 SE 69TH TER
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-9317
Mailing Address - Country:US
Mailing Address - Phone:352-209-2684
Mailing Address - Fax:
Practice Address - Street 1:3442 SE LAKE WEIR AVE STE A
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6712
Practice Address - Country:US
Practice Address - Phone:352-369-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist