Individual
ELIZABETH ELLEN BLACKSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2061 WRIGHT AVE STE A7, LA VERNE, CA 91750-5813
(909) 519-8912
Mailing address
2061 WRIGHT AVE STE A7, LA VERNE, CA 91750-5813
(909) 519-8912
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
20699
CA
Other
Enumeration date
02/17/2020
Last updated
02/17/2020
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