Individual
DR. BLAKE PONIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
801 CORPORATE CENTRE DR, O FALLON, MO 63368-8685
(636) 851-4000
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2024012844
MO
225X00000X
Occupational Therapist
31006729A
IN
Other
Enumeration date
10/19/2018
Last updated
10/21/2024
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