Individual
MR. BLAKE SANCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
3200 TROUP HWY, TYLER, TX 75701-8397
(903) 253-0095
Mailing address
3200 TROUP HWY, TYLER, TX 75701-8397
(903) 253-0095
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212430
TX
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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