Provider Demographics
NPI:1083830707
Name:PHELAN, ROBIN S (OTR)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:PHELAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 WAQUOIT HWY
Mailing Address - Street 2:
Mailing Address - City:WAQUOIT
Mailing Address - State:MA
Mailing Address - Zip Code:02536-7820
Mailing Address - Country:US
Mailing Address - Phone:508-495-1993
Mailing Address - Fax:
Practice Address - Street 1:679 WAQUOIT HWY
Practice Address - Street 2:
Practice Address - City:WAQUOIT
Practice Address - State:MA
Practice Address - Zip Code:02536-7820
Practice Address - Country:US
Practice Address - Phone:508-495-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist