Basic Information
| Provider Information | |||||||||
| NPI: | 1114427457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELEY | ||||||||
| FirstName: | BLAIR | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14320 GATEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238058066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048953003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 MASONIC LN | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232235557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042221694 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0131-001946 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.