Individual
MRS. HEATHER MICHELLE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1311 AUGUSTA RD, WEST COLUMBIA, SC 29169-6320
(803) 926-7204
Mailing address
105 CONGAREE MILL LN, WEST COLUMBIA, SC 29169-5357
(609) 731-0994
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4217
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2012
Last updated
11/19/2018
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