Individual
KAYLA BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
9379 FORESTWOOD LN, MANASSAS, VA 20110-4760
(571) 208-1298
(571) 292-1757
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
121283
TX
Other
Enumeration date
02/26/2021
Last updated
09/26/2023
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