Individual
CARLY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
12276 SAN JOSE BLVD STE 508, JACKSONVILLE, FL 32223-8618
(904) 886-3223
(904) 485-8876
Mailing address
12276 SAN JOSE BLVD STE 508, JACKSONVILLE, FL 32223-8618
(904) 886-3223
(904) 485-8876
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
20258
FL
Other
Enumeration date
09/25/2019
Last updated
01/07/2024
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