Most Relevant Information
Provider Data
| NPI Number: | 1003315615 |
| Provider Name: | AMY JO BLAKE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/09/2018 |
| Last Updated: | 02/09/2018 |
Provider Practice Location
1200 STERRETT RD
FAIRFIELD
VA
244352629
Practice Location Phone/Fax
| Phone: | 4344852890 |
| Fax: |
Provider Mailing Location
6528 MCGRAW GAP RD
HOT SPRINGS
VA
244452522
Provider Mailing Phone/Fax
| Phone: | 5406915387 |
| Fax: |