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NPI Code Detail

MEDICARE: KRISTINA N BLAKE OTR/L

MEDICARE: KRISTINA N BLAKE OTR/L
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
1225X00000XOccupational TherapistOT15041FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861764144
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA N BLAKE OTR/L
Provider Business Mailing Address
First Line : 1000 COLOR PL STE 101
Second Line :
City : APOPKA
State : FL
Zip : 32703-7717
Country : US
Telephone Number : 352-394-0212
Fax Number : 352-241-6361
Provider Business Practice Location Address
First Line : 1000 COLOR PL STE 101
Second Line :
City : APOPKA
State : FL
Zip : 32703-7717
Country : US
Telephone Number : 352-394-0212
Fax Number : 352-241-6361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 04/14/2022

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1255072153 — LANIE MCDERMOTT MS, CCC-SLP
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1508504093 — JENNIFER ANN BOCKER
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1346989902 — MRS. MICHAEL LASHON EVERHART
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Directions to “ KRISTINA N BLAKE OTR/L” Practice Location

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