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Individual

CHANEL BLAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
123 EAST 110TH STREET, SUITE 6D, NEW YORK, NY 10029
(646) 489-2579
Mailing address
123 EAST 110TH STREET, SUITE 6D, NEW YORK, NY 10029
(646) 489-2579

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
011416-01
NY
225100000X
Physical Therapist
NY
225X00000X
Occupational Therapist
NY
235Z00000X
Speech-Language Pathologist
NY
252Y00000X
Early Intervention Provider Agency
Primary
NY

Other

Enumeration date
09/21/2023
Last updated
09/21/2023
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