Blanford Pediatric Therapy LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

BLANFORD PEDIATRIC THERAPY LLC

Practice address

201 S 5TH St
Bardstown, KY 40004-1142

Phone

(502) 331-5478

Fax

(502) 385-0234

NPI assigned

Dec 4, 2017

Organization subpart

No

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

Authorized official

Name

Angie Boltwood

Title

Billing Manager

Phone

(770) 530-9051

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Lemon-Aid Mental Health Services Doing business as

Tax ID family

Blanford Pediatric Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Blanford Pediatric Therapy LLC

  • Pediatric Occupational Therapist
  • Bardstown, KY
  • NPI 1508222340
  NPD tax ID

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lance Blanford

  • Clinical Social Worker
  • Bardstown, KY
  • NPI 1750747804

  Counselor

  NPD
• Rachel M. Blanford, MSW, CSW

  • Clinical Social Worker
  • Bardstown, KY
  • NPI 1326536236

  Multi-Specialty

  NPD (past)
• Mollie Jo Carnforth, CCC-SLP

  • Speech-Language Pathologist
  • Louisville, KY
  • NPI 1609396894
  NPD (past)
• Melanie M Clements, OTRL

  • Pediatric Occupational Therapist
  • Bardstown, KY
  • NPI 1760693907
  NPD (past)
• Amanda Mattingly, DPT

  • Physical Therapy Assistant
  • Bardstown, KY
  • NPI 1740781434
  NPD (past)
• Farah Mattingly, OTR/L

  • Occupational Therapist
  • Raywick, KY
  • NPI 1801387006
  NPD (past)
• Jenny Mudd Neel, MSOT, OTR/L

  • Pediatric Occupational Therapist
  • Bardstown, KY
  • NPI 1750581443
  NPD (past)
• Hannah Osborne, OTR/L

  • Occupational Therapist
  • Chaplin, KY
  • NPI 1710412507
  NPD (past)
• Sarah K Riggs, MSCCCSLP

  • Speech-Language Pathologist
  • Bardstown, KY
  • NPI 1093943490
  NPD (past)
• Vicki A. Smith, PT

  • Physical Therapist
  • Bardstown, KY
  • NPI 1508917113
  NPD (past)

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1093220741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S 5TH ST",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400041142",
            "telephone_number": "502-331-5478",
            "fax_number": "502-385-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S 5TH ST",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400041142",
            "telephone_number": "502-331-5478",
            "fax_number": "502-385-0234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 S 4th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "KY",
            "postal_code": "404222091",
            "country_code": "US",
            "telephone_number": "502-331-5478",
            "fax_number": "502-385-0234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLANFORD PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "BOLTWOOD",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "770-530-9051"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100424590",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lemon-Aid Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela Gail Blaine, LMT
• Jessica Rae Blair, LMT
• Mary Angela Blair, MHA
• William Blake, PMHNP-BC
• Alyson Blandford, MS, OTR/L
• Blanford Pediatric Therapy LLC
• Lance Blanford
• Rachel M. Blanford, MSW, CSW
• Stanley Lawrence Block Jr., MD
• Bloomfield SNF Operations LLC

• All providers in Bardstown, KY
• Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.