Provider Demographics
NPI:1861557340
Name:BLANKENSHIP, MICHELE GAYLYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GAYLYNN
Last Name:BLANKENSHIP
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 1:9139 EMGE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-7965
Mailing Address - Country:US
Mailing Address - Phone:812-457-5228
Mailing Address - Fax:
Practice Address - Street 1:9139 EMGE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-7965
Practice Address - Country:US
Practice Address - Phone:812-457-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002462A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist