Provider Demographics
NPI:1124561675
Name:HARTLEY, ROBERT (OTL)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26616 DOMINGO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4115
Mailing Address - Country:US
Mailing Address - Phone:949-282-8127
Mailing Address - Fax:
Practice Address - Street 1:26616 DOMINGO DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-4115
Practice Address - Country:US
Practice Address - Phone:949-282-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist