Individual
STEPHANIE BLACKMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1001 E COOLEY DR, STE 101, COLTON, CA 92324-3941
(909) 783-1111
(909) 783-3957
Mailing address
1001 E COOLEY DR, STE 101, COLTON, CA 92324-3941
(909) 783-1111
(909) 783-3957
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
COTA1152
CA
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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