Provider Demographics
NPI:1083873632
Name:BLAKELY, TERRI (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 HILE LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1733
Mailing Address - Country:US
Mailing Address - Phone:937-832-9207
Mailing Address - Fax:
Practice Address - Street 1:4801 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1084
Practice Address - Country:US
Practice Address - Phone:937-236-9965
Practice Address - Fax:937-233-0161
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-03652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist