Provider Demographics
NPI:1932538618
Name:YORK, ROBERT (MOT,OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:YORK
Suffix:
Gender:M
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 RAINIER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3541
Mailing Address - Country:US
Mailing Address - Phone:815-790-8099
Mailing Address - Fax:
Practice Address - Street 1:7727 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4320
Practice Address - Country:US
Practice Address - Phone:612-455-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist