Provider Demographics
NPI:1689843500
Name:BLACKWELL, LULETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LULETTE
Middle Name:
Last Name:BLACKWELL
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 1:26938 FLOWERING OAK PL
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3822
Mailing Address - Country:US
Mailing Address - Phone:818-795-1369
Mailing Address - Fax:661-295-9776
Practice Address - Street 1:28093 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4023
Practice Address - Country:US
Practice Address - Phone:661-295-0181
Practice Address - Fax:661-295-9776
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist