Individual
KELSEY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9737 GREAT HILLS TRL STE 120, AUSTIN, TX 78759-6418
(512) 872-2180
Mailing address
10706 SPICEWOOD CLUB DR, AUSTIN, TX 78750-2838
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
120322
TX
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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