Provider Demographics
NPI:1699169326
Name:WESSELS, BLAINE
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:
Last Name:WESSELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:IA
Mailing Address - Zip Code:50478-5039
Mailing Address - Country:US
Mailing Address - Phone:515-344-5404
Mailing Address - Fax:
Practice Address - Street 1:204 3RD AVE E
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:IA
Practice Address - Zip Code:50478-5039
Practice Address - Country:US
Practice Address - Phone:515-344-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer