Provider Demographics
NPI:1619176674
Name:PETERSON, ROBYN RENEE (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:RENEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:MISS
Other - First Name:ROBYN
Other - Middle Name:RENEE
Other - Last Name:KOPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA L
Mailing Address - Street 1:307 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2027
Mailing Address - Country:US
Mailing Address - Phone:712-243-6794
Mailing Address - Fax:
Practice Address - Street 1:2027 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531
Practice Address - Country:US
Practice Address - Phone:712-764-4201
Practice Address - Fax:712-764-6200
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00345224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant