Provider Demographics
NPI:1710238779
Name:TERRY, ROBIN LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:TERRY
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 1:495 BUCK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EKRON
Mailing Address - State:KY
Mailing Address - Zip Code:40117-8715
Mailing Address - Country:US
Mailing Address - Phone:270-828-8178
Mailing Address - Fax:
Practice Address - Street 1:495 BUCK GROVE RD
Practice Address - Street 2:
Practice Address - City:EKRON
Practice Address - State:KY
Practice Address - Zip Code:40117-8715
Practice Address - Country:US
Practice Address - Phone:270-980-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY136628224Z00000X
KYA4879314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility