Provider Demographics
NPI:1457396194
Name:ORTICERIO, ROBIN M (LATC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:ORTICERIO
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-3324
Mailing Address - Country:US
Mailing Address - Phone:401-225-0375
Mailing Address - Fax:
Practice Address - Street 1:232 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-3324
Practice Address - Country:US
Practice Address - Phone:401-225-0375
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT000872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer