Individual
MR. MOZELLE BLACKMON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
5380 CRAWFORD RD, FORT LAWN, SC 29714-8562
(803) 235-3524
Mailing address
1408 JASPER RIDGE DR, FORT MILL, SC 29707-5837
(803) 235-3524
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2891
SC
Other
Enumeration date
03/31/2010
Last updated
01/21/2014
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