Provider Demographics
NPI:1346886173
Name:TITTLEY, ROBIN T
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:T
Last Name:TITTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 U ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1722
Mailing Address - Country:US
Mailing Address - Phone:301-526-9415
Mailing Address - Fax:
Practice Address - Street 1:1133 EAST WEST HIGHWAY (INSIDE SOLA SALON #14)
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2091
Practice Address - Country:US
Practice Address - Phone:301-526-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD490021744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management