Provider Demographics
NPI:1891839148
Name:BLAKEMORE, DEE A (OTR)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:A
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 HIGHWAY WW
Mailing Address - Street 2:
Mailing Address - City:ALDRICH
Mailing Address - State:MO
Mailing Address - Zip Code:65601-9200
Mailing Address - Country:US
Mailing Address - Phone:417-694-8007
Mailing Address - Fax:417-694-8007
Practice Address - Street 1:576 HIGHWAY WW
Practice Address - Street 2:
Practice Address - City:ALDRICH
Practice Address - State:MO
Practice Address - Zip Code:65601-9200
Practice Address - Country:US
Practice Address - Phone:417-694-8007
Practice Address - Fax:417-694-8007
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist