Blair Renee Church, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5492 Issued in CT

Practice address

14 2ND St
Stamford, CT 06905-5151

Phone

(203) 883-1510

NPI assigned

Aug 26, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fox Rehab OT CT LLCGroup PAC ID 1658683123, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fox Rehab OT CT, LLC

  • Occupational Therapist
  • Wilton, CT
  • NPI 1912251992
  Medicare reassignment Care Compare group NPD
• Ibis Medical Care PLLC

  • Internal Medicine Physician
  • Greenwich, CT
  • NPI 1477261915
  NPD
• Progressive Care Medical Group of CT, PLLC

  • Nurse Practitioner
  • Southport, CT
  • NPI 1679107940
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1023621224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 PEQUOT AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204407",
            "telephone_number": "860-608-5498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 2ND ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055151",
            "telephone_number": "203-883-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "BLAIR",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "5492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Skuburids, LLC (Stamford Speech Therapy)
• Aliyah Christy
• Samantha Chu
• Scott G Chudnoff, MD
• Sori Chun
• Alan D Chusid, DDS
• Carly Chussid
• John Francis Ciannella, M.D.
• Katharine Frommer Cik, PSYD
• Sylvia Cimoch, N.D.

• Occupational Therapist in Stamford, CT
• Providers in Stamford, CT by specialty
• Occupational Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.