Organization
ETIKIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE BLACKER MOT, OTR/L, MSED (OCCUPATIONAL THERAPIST)
(646) 544-4485
Entity
Organization
Contact information
Practice address
1722 MAGDALENE MANOR DR, TAMPA, FL 33613-1917
(813) 856-9449
(813) 962-6831
Mailing address
1722 MAGDALENE MANOR DR, TAMPA, FL 33613-1917
(813) 856-9449
(813) 962-6831
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
16418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013898400
—
FL
Enumeration date
09/24/2014
Last updated
11/16/2016
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