Provider Demographics
NPI:1548417520
Name:JENNINGS, ROBYN LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:LYNN
Last Name:JENNINGS
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 1:201 S NORTHPARK LN
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-8426
Mailing Address - Country:US
Mailing Address - Phone:417-623-4313
Mailing Address - Fax:417-621-0129
Practice Address - Street 1:201 S NORTHPARK LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-8426
Practice Address - Country:US
Practice Address - Phone:417-623-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004777224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant