Healthcare Provider Details

I. General information

NPI: 1497874648
Provider Name (Legal Business Name): ROBYN KERR LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 14TH ST
MODESTO CA
95354-2530
US

IV. Provider business mailing address

621 14TH ST
MODESTO CA
95354-2530
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-0373
  • Fax: 209-529-8519
Mailing address:
  • Phone: 209-569-0373
  • Fax: 209-529-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT18958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: