Provider Demographics
NPI:1962568295
Name:BLAHUTA, DANA RENAE (OTR)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RENAE
Last Name:BLAHUTA
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 1:1330 COUNTY ROAD 265
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-4887
Mailing Address - Country:US
Mailing Address - Phone:361-596-7441
Mailing Address - Fax:979-743-2185
Practice Address - Street 1:111 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1601
Practice Address - Country:US
Practice Address - Phone:979-743-6537
Practice Address - Fax:979-743-2185
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist