Individual
CHARLENE BLACKLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
(505) 266-5557
Mailing address
14200 NAMBE AVE NE, ALBUQUERQUE, NM 87123-1829
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0196
NM
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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