Provider Demographics
NPI:1467123018
Name:BLAYLOCK, JULIA KAY
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KAY
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:KAY
Other - Last Name:BLAYLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-0052
Mailing Address - Country:US
Mailing Address - Phone:580-509-5008
Mailing Address - Fax:
Practice Address - Street 1:282 N OHIO AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2040
Practice Address - Country:US
Practice Address - Phone:832-423-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician