Heather Michelle Blake

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

4217 Issued in SC

Practice address

1311 Augusta Rd
West Columbia, SC 29169-6320

Phone

(803) 926-7204

NPI assigned

May 24, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medsource Inc.

  • Durable Medical Equipment & Medical Supplies
  • West Columbia, SC
  • NPI 1538158902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1174883045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 CONGAREE MILL LN",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291695357",
            "telephone_number": "609-731-0994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 AUGUSTA RD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291696320",
            "telephone_number": "803-926-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "HEATHER",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-24",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "4217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Black, MD
• Nicholas Blackburn, PTA
• Ashlin Blackmon
• Melissa Michelle Blackmon, NP-C
• Rhonda Marcale Blackmon, LPN
• Madison McCarty Blake
• Blakemore & Dunn, Inc.
• Mary Joyce Bland, RN, BSN
• Tomer Blas
• John David Blevins, M.D.

• Occupational Therapist in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Occupational Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.