Individual
MRS. CHERITA R BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4415 RADNOR RD, INDIANAPOLIS, IN 46226-2149
(317) 542-0186
Mailing address
4415 RADNOR RD, INDIANAPOLIS, IN 46226-2149
(317) 542-0186
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000124A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200828270A
—
IN
Enumeration date
09/14/2007
Last updated
07/25/2008
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