Provider Demographics
NPI:1730982984
Name:BLAKELY, STEPHEN HERMAN JR
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HERMAN
Last Name:BLAKELY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2564
Mailing Address - Country:US
Mailing Address - Phone:614-908-6218
Mailing Address - Fax:
Practice Address - Street 1:5390 CROSSING LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5217
Practice Address - Country:US
Practice Address - Phone:614-208-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care