MEDICARE: WENDY BLACKSTONE

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	224Z00000X	Occupational Therapy Assistant	OTA3760	FL

General Provider Information

NPI Number	:	1861738361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY BLACKSTONE

Provider Business Mailing Address
First Line	:	21300 SAN SIMEON WAY APT 0-5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-1130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NE 141ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-2837
Country	:	US
Telephone Number	:	305-893-1102
Fax Number	:

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

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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Directions to “ WENDY BLACKSTONE ” Practice Location

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