Provider Demographics
NPI:1669795969
Name:ROBERT, KEVIN LEE (BS, RSPGT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:ROBERT
Suffix:
Gender:M
Credentials:BS, RSPGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WHALEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4522
Mailing Address - Country:US
Mailing Address - Phone:508-643-1979
Mailing Address - Fax:
Practice Address - Street 1:136 WHALEN DR
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4522
Practice Address - Country:US
Practice Address - Phone:508-643-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7978246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other