Provider Demographics
NPI:1003293309
Name:WILKINS, ROBERT (LMT, COTA/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
Credentials:LMT, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW STE 306
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1581
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:1901 S 72ND ST STE A-1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1200
Practice Address - Country:US
Practice Address - Phone:253-475-4870
Practice Address - Fax:253-475-4873
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60483333224Z00000X
WAMT60791072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant