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General NPI Number Information
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NPI Number | 1831056134
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Entity Type | Individual
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Provider Name | AMBER NICOLE BLAKE
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Gender | Female
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 461 POND APPLE RD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-2208
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Country | US
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Telephone | 931-920-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 3871 MCDAGIN CIR UNIT B
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-3820
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8526
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License Number State | TN
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