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General NPI Number Information
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NPI Number | 1508453127
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Entity Type | Individual
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Provider Name | JESSICA ROSE BLAIKIE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 1 ROUNDER WAY STE 225
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City | BURLINGTON
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State | MA
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Zip | 01803-5292
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Country | US
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Telephone | 781-362-4638
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Fax | 617-830-9469
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Provider Business Mailing Address
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Address Line | 104 CREST AVE
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City | REVERE
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State | MA
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Zip | 02151-4117
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Country | US
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Telephone | 339-532-9733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 13629
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License Number State | MA
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