Provider Demographics
NPI:1821011313
Name:ROBERTSON, CYNTHIA RENEE (OT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:RENEE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:3130 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2959
Practice Address - Country:US
Practice Address - Phone:419-841-9622
Practice Address - Fax:419-843-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009306225X00000X
OHOT.004097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist