Healthcare Provider Details

I. General information

NPI: 1114995107
Provider Name (Legal Business Name): BLAKE C. WEYRICH OT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 FERGUSON DR
CINCINNATI OH
45245-1680
US

IV. Provider business mailing address

218 HASTINGS ST
CINCINNATI OH
45219-1421
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-4400
  • Fax: 513-943-5323
Mailing address:
  • Phone: 513-579-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: