Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 139 | SC |
NPI | 1073571675 |
---|---|
Provider Name | Mrs. Christine Roebuck Blake |
First Address | Mt Pleasant, SC 29464-7930 |
Second Address | Mt Pleasant, SC 29464-7930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 15/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TH0689 | (05) | SC |