Provider Demographics
NPI:1235761495
Name:JORDAN, BLAKELEE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BLAKELEE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4124
Mailing Address - Country:US
Mailing Address - Phone:207-593-8165
Mailing Address - Fax:
Practice Address - Street 1:3208 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4124
Practice Address - Country:US
Practice Address - Phone:207-593-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3799225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics