Provider Demographics
NPI:1821199175
Name:BLACKWELL, JOYCE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOYCE
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 1:555 E CHEVES ST
Mailing Address - Street 2:REHAB SERVICES
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2617
Mailing Address - Country:US
Mailing Address - Phone:843-777-2250
Mailing Address - Fax:843-777-2051
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:REHAB SERVICES
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-2250
Practice Address - Fax:843-777-2051
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0483Medicaid
SCGP0334Medicaid
SC420051Medicare Oscar/Certification