Provider Demographics
NPI:1689832198
Name:POOLE, ROBERT LYNN (OTR)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LYNN
Last Name:POOLE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 EVALON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1313
Mailing Address - Country:US
Mailing Address - Phone:409-212-1858
Mailing Address - Fax:
Practice Address - Street 1:2590 EVALON AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1313
Practice Address - Country:US
Practice Address - Phone:409-212-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist