Provider Demographics
NPI:1497362107
Name:UNDERWOOD, ROBIN T (PHD, OT/L)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:T
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PHD, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 BRIARLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7005
Mailing Address - Country:US
Mailing Address - Phone:404-245-9958
Mailing Address - Fax:
Practice Address - Street 1:2335 BRIARLEIGH WAY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7005
Practice Address - Country:US
Practice Address - Phone:404-245-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA000037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA000037OtherSTATE BOARD OF OCCUPATIONAL THERAPY