Provider Demographics
NPI:1457650012
Name:BRAILEY, ROBYN (COTA)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:BRAILEY
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 1:1397 WATERTREE RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-7711
Mailing Address - Country:US
Mailing Address - Phone:812-877-2519
Mailing Address - Fax:
Practice Address - Street 1:3461 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:WEST TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47885-9683
Practice Address - Country:US
Practice Address - Phone:812-917-5618
Practice Address - Fax:812-917-5618
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001822A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant