Provider Demographics
NPI:1053600718
Name:BLUM, ABRIELLE JEANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:ABRIELLE
Middle Name:JEANNE
Last Name:BLUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LASALLE AVE
Mailing Address - Street 2:APT 414
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3468
Mailing Address - Country:US
Mailing Address - Phone:920-256-9145
Mailing Address - Fax:
Practice Address - Street 1:1500 LASALLE AVE
Practice Address - Street 2:APT 414
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3468
Practice Address - Country:US
Practice Address - Phone:920-256-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104034OtherSTATE OF MINNESOTA LICENSE