Individual
LILLIAN BLACKMON FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6508 GUNN HWY, TAMPA, FL 33625-4022
(813) 963-6923
(813) 264-0768
Mailing address
5917 TAYWOOD DRIVE, TAMPA, FL 33624
(772) 418-9240
(813) 264-0768
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT 16903
FL
225XP0200X
Pediatric Occupational Therapist
Primary
OT16903
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014555100
—
FL
01
—
14039460
CAQH
FL
Enumeration date
03/18/2015
Last updated
04/20/2021
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