Provider Demographics
NPI:1073571675
Name:BLAKE, CHRISTINE ROEBUCK (OTR L CHT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ROEBUCK
Last Name:BLAKE
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LONG POINT RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7930
Mailing Address - Country:US
Mailing Address - Phone:843-884-4783
Mailing Address - Fax:843-884-1979
Practice Address - Street 1:570 LONG POINT RD
Practice Address - Street 2:SUITE 270
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7930
Practice Address - Country:US
Practice Address - Phone:843-884-4783
Practice Address - Fax:843-884-1979
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC139225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0689Medicaid
SCTH0689Medicaid