Provider Demographics
NPI:1407184583
Name:MACROBERTS, VICKI LEE
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LEE
Last Name:MACROBERTS
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 1:3313 W 78TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5117
Mailing Address - Country:US
Mailing Address - Phone:219-794-1032
Mailing Address - Fax:
Practice Address - Street 1:3313 W 78TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5117
Practice Address - Country:US
Practice Address - Phone:219-794-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist