Provider Demographics
NPI:1457943581
Name:BLACKMAN, THERESA (OT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BLACKMAN
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 1:761 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2117
Mailing Address - Country:US
Mailing Address - Phone:180-034-2771
Mailing Address - Fax:
Practice Address - Street 1:761 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2117
Practice Address - Country:US
Practice Address - Phone:800-342-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist