Individual
STACI BLANKENSHIP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4358 HWY PP, POPLAR BLUFF, MO 63901-1530
(573) 686-5439
(573) 778-0103
Mailing address
PO BOX 1296, POPLAR BLUFF, MO 63902-1296
(573) 686-5439
(573) 778-0103
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2003011549
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
475775235
—
MO
Enumeration date
04/13/2006
Last updated
09/16/2010
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