Individual
KARLA ANNETTE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
858 STARLIGHT CT, HERRIN, IL 62948-2445
(618) 942-5096
(618) 987-4163
Mailing address
858 STARLIGHT CT, HERRIN, IL 62948-2445
(618) 942-5096
(618) 987-4163
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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