Courtney Blake

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

076277 Issued in IA

Practice address

500 Vermillion St
Centerville, SD 57014-2168

Phone

(605) 212-3446

NPI assigned

Dec 14, 2015

Last updated

Dec 14, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1942675152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29468 466TH AVE",
            "city": "CENTERVILLE",
            "state": "SD",
            "postal_code": "570146308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VERMILLION ST",
            "city": "CENTERVILLE",
            "state": "SD",
            "postal_code": "570142168",
            "telephone_number": "605-212-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IA",
            "license": "076277",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SD",
            "license": "0967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Adam Bennett, RN
• Jake Broscha
• Cody D Carstensen, PHARMD
• Centerville Care & Rehab Center Inc
• Centerville Community Ambulance Service, Inc.
• Centerville Development Corporation (Centerville Care and Rehab Center)

• Occupational Therapist in Centerville, SD
• Providers in Centerville, SD by specialty
• Occupational Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.