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1396223129
KELLY JAMES BLAKE
WATERFORD, MI
NPI
1396223129
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: MI 5201004341)
Enumeration Date
2018-08-02
Last Update Date
2018-08-02
Business Address
KELLY JAMES BLAKE OTR
1901 N TELEGRAPH RD
WATERFORD, MI 48328-1878
Phone number: 248-836-1000
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Mailing Address
KELLY JAMES BLAKE OTR
3257 WHITFIELD CT
WATERFORD, MI 48329-2769
Phone number: 248-330-1770
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