Provider Demographics
NPI:1528374295
Name:FUGAZZI, ROBIN HOLMES (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:HOLMES
Last Name:FUGAZZI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:78 HOOVER LANE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-4647
Mailing Address - Country:US
Mailing Address - Phone:207-794-3253
Mailing Address - Fax:
Practice Address - Street 1:23 ELLA P. BURR (ELEMENTARY SCHOOL) ROAD
Practice Address - Street 2:ELLA P. BURR ELEMENTARY SCHOOL
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4647
Practice Address - Country:US
Practice Address - Phone:207-794-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT331225X00000X
MA169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist