Provider Demographics
NPI:1265872501
Name:ROBERTS, ROBYN ABBOTT (PT,OT,)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:ABBOTT
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT,OT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 LAKELAND DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5038
Mailing Address - Country:US
Mailing Address - Phone:601-942-2709
Mailing Address - Fax:
Practice Address - Street 1:1904 LAKELAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5038
Practice Address - Country:US
Practice Address - Phone:601-942-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0987174400000X
MS45OT073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist