Provider Demographics
NPI:1366292278
Name:BLANE, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BLANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5280
Mailing Address - Country:US
Mailing Address - Phone:775-360-3206
Mailing Address - Fax:775-490-3001
Practice Address - Street 1:3685 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5280
Practice Address - Country:US
Practice Address - Phone:775-360-3206
Practice Address - Fax:775-490-3001
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT3235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist