Provider Demographics
NPI:1235518028
Name:ROBYN COLLEY OTR/L LLC
Entity Type:Organization
Organization Name:ROBYN COLLEY OTR/L LLC
Other - Org Name:WHOLE CHILD INTEGRATIVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:407-636-6924
Mailing Address - Street 1:2989 W STATE ROAD 434
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4463
Mailing Address - Country:US
Mailing Address - Phone:407-636-6924
Mailing Address - Fax:407-982-3357
Practice Address - Street 1:2989 W STATE ROAD 434
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4463
Practice Address - Country:US
Practice Address - Phone:407-636-6924
Practice Address - Fax:407-982-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12727224Z00000X
FLOT 15248225X00000X
FLOT8386225XP0200X
FLSA5268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400952OtherAVAILITY CLEARINGHOUSE