Provider Demographics
NPI:1528734563
Name:BLOCKSIDGE, ABBEGAIL MEREDITH
Entity type:Individual
Prefix:
First Name:ABBEGAIL
Middle Name:MEREDITH
Last Name:BLOCKSIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:MEREDITH
Other - Last Name:BLOCKSIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8567 HOLIDAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2629
Mailing Address - Country:US
Mailing Address - Phone:513-305-6299
Mailing Address - Fax:
Practice Address - Street 1:453 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2205
Practice Address - Country:US
Practice Address - Phone:614-292-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer