MEDICARE: ROBERTSON BAUTISTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	010049-01	NY

General Provider Information

NPI Number	:	1558227702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTSON BAUTISTA

Provider Business Mailing Address
First Line	:	39 LANRAM RD
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1735
Country	:	US
Telephone Number	:	845-668-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 LANRAM RD
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1735
Country	:	US
Telephone Number	:	845-668-0255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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Directions to “ ROBERTSON BAUTISTA ” Practice Location

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