Individual
TANEKA M. BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L, CAPS
Contact information
Practice address
5025 VILLAGE FOUNTAIN PL, CENTREVILLE, VA 20120-3075
(850) 321-6993
Mailing address
5025 VILLAGE FOUNTAIN PL, CENTREVILLE, VA 20120-3075
(850) 321-6993
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
02/13/2021
Last updated
02/13/2021
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