Provider Demographics
NPI:1598928970
Name:HODGIN, ROBERTA REBECCA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:REBECCA
Last Name:HODGIN
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 1:1901 S PARK RD APT A201
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6153
Mailing Address - Country:US
Mailing Address - Phone:765-455-3712
Mailing Address - Fax:
Practice Address - Street 1:429 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3508
Practice Address - Country:US
Practice Address - Phone:765-453-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000783A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant