Most Relevant Information
Provider Data
| NPI Number: | 1003351438 |
| Provider Name: | RON BLAKE |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 102071 |
Most Important Dates
| Enumeration Date: | 12/20/2016 |
| Last Updated: | 12/20/2016 |
Provider Practice Location
4607 MANCHACA RD
AUSTIN
TX
787451607
Practice Location Phone/Fax
| Phone: | 5129161511 |
| Fax: | 5129161532 |
Provider Mailing Location
4607 MANCHACA RD
AUSTIN
TX
787451607
Provider Mailing Phone/Fax
| Phone: | 5129161511 |
| Fax: | 5129161532 |