Provider Demographics
NPI:1821134669
Name:HOBBS, ROBERT DARYL (OT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DARYL
Last Name:HOBBS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ROME LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9076
Mailing Address - Country:US
Mailing Address - Phone:505-265-4906
Mailing Address - Fax:505-265-9146
Practice Address - Street 1:107 ROME LN
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9076
Practice Address - Country:US
Practice Address - Phone:505-265-4906
Practice Address - Fax:505-265-9146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1147OtherNM OT LICENSE
NMR-9037Medicaid
NMD-4022Medicaid