Provider Demographics
NPI:1144941725
Name:BLASCHKE, JENNA MARIE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MARIE
Last Name:BLASCHKE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:GAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3100 ASHLEY TOWN CENTER DR.
Mailing Address - Street 2:APT. 340
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414
Mailing Address - Country:US
Mailing Address - Phone:803-459-6403
Mailing Address - Fax:
Practice Address - Street 1:3100 ASHLEY TOWN CENTER DR APT 340
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5685
Practice Address - Country:US
Practice Address - Phone:803-459-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist