Basic Information
| Provider Information | |||||||||
| NPI: | 1265969786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEAN | ||||||||
| FirstName: | BLONDINE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8050 SAG HARBOR CIR APT 301 | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380165997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864685441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9000 BURMA RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334031606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615086122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 7091 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.