Provider Demographics
NPI:1588967715
Name:BLAIN, BARBARA P (OTR)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:P
Last Name:BLAIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8224 MANN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-9638
Mailing Address - Country:US
Mailing Address - Phone:317-442-4734
Mailing Address - Fax:317-791-9001
Practice Address - Street 1:6303 S EAST ST
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7114
Practice Address - Country:US
Practice Address - Phone:317-791-9031
Practice Address - Fax:317-791-9001
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001006 A225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200731390 AMedicaid