MEDICARE: JUSTIN D BLOCKI 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
1	225X00000X	Occupational Therapist	OC011662	PA

General Provider Information

NPI Number	:	1982904199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN D BLOCKI OTR/L

Provider Business Mailing Address
First Line	:	1613 SE 7TH ST
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5813
Country	:	US
Telephone Number	:	484-894-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 SE 7TH ST
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5813
Country	:	US
Telephone Number	:	484-894-3207
Fax Number	:

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

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	03/20/2020

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