Individual
MR. OTIS FLETCHER BLANKENSHIP IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 MULLINS DR, LEBANON, OR 97355-3983
(541) 259-0200
Mailing address
23 GROVE ST, LEBANON, OR 97355-4314
(541) 660-7592
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/06/2026
Last updated
04/06/2026
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