Individual
LISA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1323 S ASH ST, BUFFALO, MO 65622-9311
(417) 345-2222
Mailing address
65 WEEKS DR, BUFFALO, MO 65622-4116
(417) 619-4640
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2004016764
MO
Other
Enumeration date
09/06/2024
Last updated
09/06/2024
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