Provider Demographics
NPI:1770295677
Name:ROBIN MICHELLE GREGORY
Entity type:Organization
Organization Name:ROBIN MICHELLE GREGORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-310-0956
Mailing Address - Street 1:2645 CLARK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-7128
Mailing Address - Country:US
Mailing Address - Phone:606-310-0956
Mailing Address - Fax:
Practice Address - Street 1:2645 CLARK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-7128
Practice Address - Country:US
Practice Address - Phone:606-310-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty