Provider Demographics
NPI:1235675232
Name:ROBIN L. WURSTER
Entity Type:Organization
Organization Name:ROBIN L. WURSTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WURSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-307-0263
Mailing Address - Street 1:10831 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2126
Mailing Address - Country:US
Mailing Address - Phone:708-307-0263
Mailing Address - Fax:
Practice Address - Street 1:10831 OAK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2126
Practice Address - Country:US
Practice Address - Phone:708-307-0263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty