Individual
MYA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3533 MOTOR AVE, LOS ANGELES, CA 90034-4806
(310) 836-8900
Mailing address
1120 N 103RD PLZ STE 300, OMAHA, NE 68114-1119
(800) 811-0064
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA7153
CA
Other
Enumeration date
04/08/2022
Last updated
10/09/2025
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