Individual
SHERRY LEE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
12840 83RD AVE, ROSELAND, FL 32957
(772) 532-0853
(772) 571-6190
Mailing address
PO BOX 1175, ROSELAND, FL 32957-1175
(772) 532-0853
(772) 571-6190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT 2648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006673400
—
FL
Enumeration date
06/28/2007
Last updated
11/30/2012
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