Provider Demographics
NPI:1538400635
Name:BLACKER, JULIE T (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:T
Last Name:BLACKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13602 S VILLAGE DR
Mailing Address - Street 2:#204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8334
Mailing Address - Country:US
Mailing Address - Phone:646-544-4485
Mailing Address - Fax:813-960-5483
Practice Address - Street 1:13602 S VILLAGE DR
Practice Address - Street 2:#204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8334
Practice Address - Country:US
Practice Address - Phone:646-544-4485
Practice Address - Fax:813-960-5483
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00606500225X00000X
FLOT 16418225X00000X
NY017705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist