Provider Demographics
NPI:1992207344
Name:ROBERTSON, RABUN MARIE (OTD, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:RABUN
Middle Name:MARIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MS
Other - First Name:RABUN
Other - Middle Name:MARIE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2320 PERIMETER PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:770-393-9901
Mailing Address - Fax:770-936-4601
Practice Address - Street 1:2320 PERIMETER PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:770-393-9901
Practice Address - Fax:770-936-4601
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006976225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics