Provider Demographics
NPI:1538477203
Name:BLAKE, ANNE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:CARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4772
Mailing Address - Country:US
Mailing Address - Phone:207-892-2872
Mailing Address - Fax:
Practice Address - Street 1:228 WINDHAM CENTER RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4862
Practice Address - Country:US
Practice Address - Phone:207-892-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174400000XOther Service ProvidersSpecialist