MEDICARE: DEBORAH BLALOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	1227	NC

General Provider Information

NPI Number	:	1730036377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH BLALOCK

Provider Business Mailing Address
First Line	:	5762 BLALOCK RD
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-7537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	JONES ELEMENTARY SCHOOL
Second Line	:	4028 HIGHWAY 42
City	:	WILSON
State	:	NC
Zip	:	27893
Country	:	US
Telephone Number	:	252-265-4020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ DEBORAH BLALOCK ” Practice Location

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