Provider Demographics
NPI:1215225420
Name:NUSS, ROBIN AMBER (MED, OT, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:AMBER
Last Name:NUSS
Suffix:
Gender:F
Credentials:MED, OT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ASPEN CIR
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-8608
Mailing Address - Country:US
Mailing Address - Phone:719-424-2280
Mailing Address - Fax:
Practice Address - Street 1:239 ASPEN CIR
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-8608
Practice Address - Country:US
Practice Address - Phone:719-424-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3058225X00000X
CO1-12-11417103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist