Provider Demographics
NPI:1184189482
Name:ROBINSON, JACQUELYN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:CRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13203 E FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0201
Mailing Address - Country:US
Mailing Address - Phone:509-262-8484
Mailing Address - Fax:
Practice Address - Street 1:19307 E CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-9489
Practice Address - Country:US
Practice Address - Phone:509-558-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60917866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist