Individual
BLAKE ERIC SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
169 VALENTINE RD, PITTSFIELD, MA 01201-3042
(413) 445-2300
Mailing address
12 BENA ST, PITTSFIELD, MA 01201-1011
(413) 770-6383
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008716-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277684274
TRICARE
MA
Enumeration date
09/03/2015
Last updated
09/03/2015
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