Provider Demographics
NPI:1588981054
Name:BLANKENHEIM OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:BLANKENHEIM OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-830-6697
Mailing Address - Street 1:1650 TRI PARK WAY
Mailing Address - Street 2:STE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1652
Mailing Address - Country:US
Mailing Address - Phone:920-830-6697
Mailing Address - Fax:920-830-6707
Practice Address - Street 1:75 PANORAMA CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2303
Practice Address - Country:US
Practice Address - Phone:920-830-6697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty