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NPI Code Detail

MEDICARE: KIMBERLY BLAKELY OT

MEDICARE: KIMBERLY BLAKELY OT
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
1225XH1200XHand Occupational TherapistOT 11602FL

General Provider Information

NPI Number : 1568853836
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY BLAKELY OT
Provider Business Mailing Address
First Line : 231 N NEW YORK AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-3117
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 231 N NEW YORK AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-3117
Country : US
Telephone Number : 407-599-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2015
Last Update Date : 02/09/2015

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Directions to “ KIMBERLY BLAKELY OT” Practice Location

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