1003079336 NPI number — MS. JENNIFER HOLLAND BLYER OTR/L

Table of content: MS. JENNIFER HOLLAND BLYER OTR/L (NPI 1003079336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003079336 NPI number — MS. JENNIFER HOLLAND BLYER OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLYER
Provider First Name:
JENNIFER
Provider Middle Name:
HOLLAND
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLAND
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003079336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HEARTHSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03825-7373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-674-5260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1386 NH ROUTE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMANTON IRON WORKS
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03837-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-364-5681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1934 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)