Basic Information
| Provider Information | |||||||||
| NPI: | 1881169829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLASKI | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 W 61ST AVE | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463426490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199476580 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 320 W 61ST AVE | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463426490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199476580 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2018 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225X00000X | 31007662A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.