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1104903020
WILLIAM RUSSELL BLAYLOCK
CARROLLTON, TX
NPI
1104903020
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: TX 103091)
Enumeration Date
2006-11-01
Last Update Date
2007-10-29
Business Address
Mr. WILLIAM RUSSELL BLAYLOCK OTR
1912 E HEBRON PKWY #104
CARROLLTON, TX 75007
Phone number: 972-492-0383
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Mailing Address
Mr. WILLIAM RUSSELL BLAYLOCK OTR
1803 PEACH TREE CT
ALLEN, TX 75002
Phone number: 972-492-0383
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