Provider Demographics
NPI:1164636916
Name:ROBINSON, KATHERINE LEWIS (OT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEWIS
Last Name:ROBINSON
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 1:4431 GOSHAWK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3670
Mailing Address - Country:US
Mailing Address - Phone:501-626-2681
Mailing Address - Fax:
Practice Address - Street 1:207 FRED RAINS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5457
Practice Address - Country:US
Practice Address - Phone:501-834-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1635225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150030721Medicaid