Provider Demographics
NPI:1922690957
Name:MEDINA, ROBIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:MEDINA
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 1:521 SHENANDOAH LN
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6208
Mailing Address - Country:US
Mailing Address - Phone:678-427-5440
Mailing Address - Fax:
Practice Address - Street 1:521 SHENANDOAH LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6208
Practice Address - Country:US
Practice Address - Phone:678-427-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist