Andrea Blake, OTR
Individual provider Active NPI Occupational Therapist · Wilton, CT
NPI 1669088100 · NPPES record last updated Sep 21, 2020
Key facts
- NPI
- 1669088100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 5513 (CT)
- Practice address
- 17 Woodchuck LN
Wilton, CT 06897-3427 - Phone
- (347) 604-4574
- NPI assigned
- Sep 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
17 Woodchuck LN
Wilton, CT 06897-3427
36 Russ St
FL 3
Hartford, CT 06106-1520
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260225002543 | CT | Practitioner - Occupational Therapist in Private Practice | 2163903303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prestige Rehab CT PLLC | Current |
Accepting new patients |
Locations
36 Russ St
Fl 3
Hartford, CT 06106
Phone (301) 785-2099
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5513 | CT | Yes |
Addresses
Primary practice location
17 Woodchuck LN
Wilton, CT 06897-3427
Mailing address
17 Woodchuck LN
Wilton, CT 06897-3427
Other providers in Wilton, CT
- Stephanie Bellino
- Amy Campbell Bender
- Sally R. Bergwerk
- Brandon Bico
- Kristina Bikoulova
- Bobbyjo Bloom
- Lauren Blose
- Blue ABA Connecticut LLC
- Richard S Boas
- Lauren Boggs
All providers in Wilton, CT · Occupational Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.