Individual
ASHAY BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIRLOSS PRACTITION
Contact information
Practice address
107 N ROYAL TOWER DR STE I, IRMO, SC 29063-2782
(803) 497-4825
Mailing address
112 SONNING RD, IRMO, SC 29063-2507
(803) 497-4825
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
—
—
225000000X
Orthotic Fitter
—
—
246Z00000X
Other Specialist/Technologist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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