Provider Demographics
NPI:1437409539
Name:DAVIDSON, ROBIN ANNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ANNE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:PARNELL
Mailing Address - State:MO
Mailing Address - Zip Code:64475-8119
Mailing Address - Country:US
Mailing Address - Phone:660-254-0635
Mailing Address - Fax:
Practice Address - Street 1:16415 HIGHWAY B
Practice Address - Street 2:
Practice Address - City:PARNELL
Practice Address - State:MO
Practice Address - Zip Code:64475-8119
Practice Address - Country:US
Practice Address - Phone:660-254-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001048224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant