Provider Demographics
NPI:1821711540
Name:BLAKE, SEPTEMBER ANN (LMT)
Entity Type:Individual
Prefix:
First Name:SEPTEMBER
Middle Name:ANN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9429
Mailing Address - Country:US
Mailing Address - Phone:207-281-3505
Mailing Address - Fax:
Practice Address - Street 1:6 WELLSPRING RD STE 206
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-8418
Practice Address - Country:US
Practice Address - Phone:207-494-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist