Individual
MS. SUSAN M BLACKMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
700 S HENDERSON RD, SUITE 200, KING OF PRUSSIA, PA 19406-3530
(610) 768-5940
(610) 768-5947
Mailing address
700 S HENDERSON RD, SUITE 200, KING OF PRUSSIA, PA 19406-3530
(610) 768-5940
(610) 768-5947
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OC001407L
PA
225XH1200X
Hand Occupational Therapist
Primary
OC001407L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1452890
IBC - PERSONAL CHOICE
PA
01
—
2138759000
IBC - KEYSTONE
PA
Enumeration date
12/01/2006
Last updated
08/23/2007
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