Provider Demographics
NPI:1851553739
Name:ROBBINS, MIRANDA JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JO
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1150
Mailing Address - Country:US
Mailing Address - Phone:270-692-3121
Mailing Address - Fax:
Practice Address - Street 1:337 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1150
Practice Address - Country:US
Practice Address - Phone:270-692-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R1907314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY$$$$$$$$$OtherSOCIAL SECURITY