Active NPI
Mozelle Blackmon Jr., OT
- Occupational Therapist
- Fort Lawn, SC
National Provider Identifier
1942525134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2891
- Practice address
- 5380 Crawford Rd
Fort Lawn, SC 29714-8562 - Phone
- (803) 235-3524
- NPI assigned
- Mar 31, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 Therapist | 225X00000X | 2891 | SC | Primary |
Addresses
Primary practice location
5380 Crawford Rd
Fort Lawn, SC 29714-8562
Mailing address
1408 Jasper Ridge Dr
Fort Mill, SC 29707-5837
Phone (803) 235-3524
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390262400000",
"number": "1942525134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1408 JASPER RIDGE DR",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297075837",
"telephone_number": "803-235-3524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5380 CRAWFORD RD",
"city": "FORT LAWN",
"state": "SC",
"postal_code": "297148562",
"telephone_number": "803-235-3524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "MOZELLE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-31",
"last_updated": "2014-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "2891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lawn, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.