Individual
DERRICKER BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3769 NOSTRAND AVE, BROOKLYN, NY 11235-2041
(718) 769-9888
Mailing address
14 GRANT ST, TUCKAHOE, NY 10707-4152
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0087221
NY
Other
Enumeration date
09/01/2017
Last updated
09/01/2017
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