Individual
BETTY A BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 605-8869
Mailing address
315 VIKING DR, COLUMBUS, MS 39702-8390
(662) 327-1252
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1628
MS
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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