Active NPI
Jeremy Khalil Blakley, COTA/L
- Occupational Therapy Assistant
- Greenville, SC
National Provider Identifier
1194398073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5257
- Practice address
- 811 Pine Creek Dr
Greenville, SC 29605-3421 - Phone
- (864) 395-6358
- NPI assigned
- Jul 20, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5257 | SC | Primary |
Addresses
Primary practice location
811 Pine Creek Dr
Greenville, SC 29605-3421
Mailing address
811 Pine Creek Dr
Greenville, SC 29605-3421
Phone (864) 395-6358
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5257 | SC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626739200000",
"number": "1194398073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 PINE CREEK DR",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296053421",
"telephone_number": "864-395-6358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 PINE CREEK DR",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296053421",
"telephone_number": "864-395-6358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKLEY",
"first_name": "JEREMY",
"middle_name": "KHALIL",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-20",
"last_updated": "2021-07-20",
"certification_date": "2021-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "SC",
"license": "5257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.