BLAKE PONIST

O FALLON, MO
NPI1932675766
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225X00000X Occupational Therapist
(Licence: MO  2024012844)
Additional Taxonomies225X00000X Occupational Therapist
(Licence: IN  31006729A)
Enumeration Date2018-10-19
Last Update Date2024-10-21
Business Address
Dr. BLAKE PONIST OT
801 CORPORATE CENTRE DR
O FALLON, MO 63368-8685
Phone number: 636-851-4000
Mailing Address
Dr. BLAKE PONIST OT
600 OAKMONT LN STE 600C
WESTMONT, IL 60559-5548
Phone number: 630-575-6250