Individual
MR. MICHAEL SHIELDS BLAKE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7212
Mailing address
4894 W 14TH ST, CLEVELAND, OH 44109-5659
(440) 554-6560
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
14466
MA
Other
Enumeration date
06/07/2022
Last updated
06/07/2022
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