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Individual

MRS. TORI BREANNE BLACKWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MOT, OTR/L

Contact information

Practice address
3731-A 6TH AVENUE, SAN DIEGO, CA 92103
(619) 291-3515
(619) 374-2552
Mailing address
3731-A 6TH AVENUE, SAN DIEGO, CA 92103
(619) 291-3515
(619) 374-2552

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT007091
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OT007091
STATE BOARD OF OCCUPATIONAL THERAPY
GA
Enumeration date
07/26/2018
Last updated
02/20/2020
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