Basic Information
| Provider Information | |||||||||
| NPI: | 1154040012 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BLAIR | ||||||||
| FirstName: | TYLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 WILSON RD | ||||||||
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| City: | SARANAC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129813936 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 NEW YORK RD | ||||||||
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| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129033981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.