Provider Demographics
NPI:1316223720
Name:MIKULAS, ROBYN JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:JEAN
Last Name:MIKULAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3015
Mailing Address - Country:US
Mailing Address - Phone:516-248-3656
Mailing Address - Fax:516-248-0995
Practice Address - Street 1:100 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1854
Practice Address - Country:US
Practice Address - Phone:631-262-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics