Provider Demographics
NPI:1821302894
Name:ROBIN, JENNIFER (NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:ROBIN
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3672
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-3672
Mailing Address - Country:US
Mailing Address - Phone:918-916-3049
Mailing Address - Fax:
Practice Address - Street 1:502 E CHICKASAW AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5305
Practice Address - Country:US
Practice Address - Phone:918-916-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist