Provider Demographics
NPI:1699914390
Name:BLAZEY, PATRICIA A (OTR)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BLAZEY
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 1:265 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13811-5205
Mailing Address - Country:US
Mailing Address - Phone:607-642-8689
Mailing Address - Fax:
Practice Address - Street 1:265 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811-5205
Practice Address - Country:US
Practice Address - Phone:607-642-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003129-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics