Provider Demographics
NPI:1508649047
Name:ROBINSON, SHAYLA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 N HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8513
Mailing Address - Country:US
Mailing Address - Phone:256-735-8553
Mailing Address - Fax:
Practice Address - Street 1:2333 N BRENTWOOD CIR
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8536
Practice Address - Country:US
Practice Address - Phone:352-746-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202009847224Z00000X
FL19615224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant