Individual
IKEIYA MARIE BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 E AUGUSTA ST, MCCORMICK, SC 29835
(864) 550-3900
Mailing address
2643 SHELTON RD, BLAIR, SC 29015-9220
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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