Provider Demographics
NPI:1740497130
Name:LEARY, ROBIN JOAN
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:JOAN
Last Name:LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:JOAN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:787 HIDDEN SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-6234
Mailing Address - Country:US
Mailing Address - Phone:208-265-8202
Mailing Address - Fax:
Practice Address - Street 1:1125 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2148
Practice Address - Country:US
Practice Address - Phone:208-265-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist