Individual
MRS. TRINA NICOLE BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
101 CHAPEL GROVE CT, WENTZVILLE, MO 63385-4339
(636) 443-5379
Mailing address
101 CHAPEL GROVE CT, WENTZVILLE, MO 63385-4339
(636) 443-5379
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2011022964
MO
Other
Enumeration date
06/26/2012
Last updated
12/19/2022
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