Provider Demographics
NPI:1821173865
Name:ROBERTSON, DARLENE ANNE (OTR/L, C/NDT)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ANNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OTR/L, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HANOVER ST
Mailing Address - Street 2:SUTE 408
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3987
Mailing Address - Country:US
Mailing Address - Phone:678-591-3542
Mailing Address - Fax:770-234-6837
Practice Address - Street 1:1475 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE113
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2139
Practice Address - Country:US
Practice Address - Phone:678-591-3542
Practice Address - Fax:770-234-6837
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002966225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00896992GMedicaid