Individual
KAMEELAH CORUM BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6000 PARK SOUTH DR, CHARLOTTE, NC 28210-3298
(704) 643-1400
Mailing address
1920 HAMILTON FOREST DR, CHARLOTTE, NC 28216-1829
(336) 583-8442
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7578
NC
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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