Provider Demographics
NPI:1912023607
Name:HORBERT, TINA I (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:I
Last Name:HORBERT
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 1:11 SHEAN ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-1119
Mailing Address - Country:US
Mailing Address - Phone:401-943-8711
Mailing Address - Fax:
Practice Address - Street 1:400 MASSASOIT AVE STE 113
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2040
Practice Address - Country:US
Practice Address - Phone:401-490-7610
Practice Address - Fax:401-490-7614
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00188224Z00000X
RIOT01356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant