Provider Demographics
NPI:1710699954
Name:GREGORY, ROBIN M
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 CLARK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-7128
Mailing Address - Country:US
Mailing Address - Phone:606-310-0956
Mailing Address - Fax:
Practice Address - Street 1:2645 CLARK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-7128
Practice Address - Country:US
Practice Address - Phone:606-310-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2023-01-04
Deactivation Date:2022-12-22
Deactivation Code:
Reactivation Date:2023-01-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist