Provider Demographics
NPI:1366294993
Name:DILLEY, BLAISE
Entity type:Individual
Prefix:
First Name:BLAISE
Middle Name:
Last Name:DILLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9641
Mailing Address - Country:US
Mailing Address - Phone:937-684-6423
Mailing Address - Fax:
Practice Address - Street 1:1044 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9641
Practice Address - Country:US
Practice Address - Phone:937-684-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child