Provider Demographics
NPI:1033542261
Name:BLOCKLEY, LOIS REBECCA
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:REBECCA
Last Name:BLOCKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DOGWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-5118
Mailing Address - Country:US
Mailing Address - Phone:706-659-1377
Mailing Address - Fax:706-659-1377
Practice Address - Street 1:215 DOGWOOD LN SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-5118
Practice Address - Country:US
Practice Address - Phone:706-659-1377
Practice Address - Fax:706-659-1377
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency