Pamela L Blake, OTD, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

002088 Issued in OH

Practice address

3355 Medina Rd
Medina, OH 44256-9631

Phone

(440) 567-5220

NPI assigned

Feb 8, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Fun 2 Be Me Developmental Therapy LLC

  • Specialist
  • Medina, OH
  • NPI 1619002227
  NPD (past) Authorized official

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1457058760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 MEDINA RD",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442569631",
            "telephone_number": "440-567-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 MEDINA RD",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442569631",
            "telephone_number": "440-567-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "PAMELA",
        "middle_name": "L",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-08",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "OH",
            "license": "002088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND ATHLETIC TRAINERS BOARD",
            "identifier": "OT002088",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Black, APRN
• Emalee Grace Black
• Joseph Bruce Blackburn, MD
• Janelle Marie Blackwell
• Laura Blake
• Lindsey Bland
• Blue Willow Medical Transport
• Ronald A Blue, PC
• Michael Blumenthal
• Wendy Sue Bobey, COTA/L

• Pediatric Occupational Therapist in Medina, OH
• Providers in Medina, OH by specialty
• Pediatric Occupational Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.