Provider Demographics
NPI:1568916450
Name:ROBERTS, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RUBY DR
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-9118
Mailing Address - Country:US
Mailing Address - Phone:501-681-9325
Mailing Address - Fax:
Practice Address - Street 1:1000 RUBY DR
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132-9118
Practice Address - Country:US
Practice Address - Phone:501-681-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A910224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant