Individual
BLAKE HAVERTON LORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
215 14TH ST APT 14, HUNTINGTON BEACH, CA 92648-4451
(970) 485-1779
Mailing address
215 14TH ST APT 14, HUNTINGTON BEACH, CA 92648-4451
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
18662
CA
Other
Enumeration date
09/28/2022
Last updated
09/28/2022
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