Provider Demographics
NPI:1659511343
Name:BLACKWELL, ANGELA LABRIE (PHD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LABRIE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 BROOKSIDE PLZ
Mailing Address - Street 2:UNIT 148
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1709
Mailing Address - Country:US
Mailing Address - Phone:816-582-4181
Mailing Address - Fax:
Practice Address - Street 1:6320 BROOKSIDE PLZ
Practice Address - Street 2:UNIT 148
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1709
Practice Address - Country:US
Practice Address - Phone:816-582-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist