Provider Demographics
NPI:1629748017
Name:WOOTEN, ROBERT DUFFY
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DUFFY
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 FOLEY RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8408
Mailing Address - Country:US
Mailing Address - Phone:115-174-1049
Mailing Address - Fax:
Practice Address - Street 1:13030 FOLEY RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8408
Practice Address - Country:US
Practice Address - Phone:115-174-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist