Individual
JEREMY KHALIL BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
811 PINE CREEK DR, GREENVILLE, SC 29605-3421
(864) 395-6358
Mailing address
811 PINE CREEK DR, GREENVILLE, SC 29605-3421
(864) 395-6358
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5257
SC
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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