Provider Demographics
NPI:1144477928
Name:BLEVINS, ANGIE SUE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:SUE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BETH DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-3807
Mailing Address - Country:US
Mailing Address - Phone:606-348-0422
Mailing Address - Fax:
Practice Address - Street 1:37 BETH DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-3807
Practice Address - Country:US
Practice Address - Phone:606-348-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist