Individual
LORI E B BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 MONTROSE AVE, PORTLAND, ME 04103-2444
(617) 694-5208
Mailing address
101 MONTROSE AVE, PORTLAND, ME 04103-2444
(617) 694-5208
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2216
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
433349399
MAINE CARE PROVIDER NUMBER
ME
01
—
OT 2216
STATE LICENSE NUMBER
ME
Enumeration date
04/16/2009
Last updated
12/29/2023
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