Provider Demographics
NPI:1437393709
Name:BARTHOLOMEW, ROBIN GRAY
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:GRAY
Last Name:BARTHOLOMEW
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 1:28 WINDING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ME
Mailing Address - Zip Code:04005-7343
Mailing Address - Country:US
Mailing Address - Phone:207-499-0120
Mailing Address - Fax:
Practice Address - Street 1:28 WINDING BROOK LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ME
Practice Address - Zip Code:04005-7343
Practice Address - Country:US
Practice Address - Phone:207-499-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME217968222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME202190000Medicaid