Provider Demographics
NPI:1083771752
Name:ROBERTSON, DEBBIE ANN (OT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5701
Mailing Address - Country:US
Mailing Address - Phone:901-818-9746
Mailing Address - Fax:901-818-9741
Practice Address - Street 1:5039 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5701
Practice Address - Country:US
Practice Address - Phone:901-818-9746
Practice Address - Fax:901-818-9741
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00001232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043585OtherPROVIDER (INDIVIDUAL #)