Provider Demographics
NPI:1881884484
Name:ROBINSON, KERI (MA)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RHODODENDRON TRL
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9563
Mailing Address - Country:US
Mailing Address - Phone:304-617-6482
Mailing Address - Fax:866-600-0015
Practice Address - Street 1:115 RHODODENDRON TRL
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9563
Practice Address - Country:US
Practice Address - Phone:304-617-6482
Practice Address - Fax:866-600-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 174400000X, 171W00000X
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No171W00000XOther Service ProvidersContractor