Provider Demographics
NPI:1831643345
Name:BLACKWELL, EMILIA (OT)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-6481
Mailing Address - Country:US
Mailing Address - Phone:228-990-0576
Mailing Address - Fax:
Practice Address - Street 1:921 COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-6481
Practice Address - Country:US
Practice Address - Phone:228-990-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist