Healthcare Provider Details

I. General information

NPI: 1447215058
Provider Name (Legal Business Name): ROBIN GARDINER OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FRONT ST
WYOMING DE
19934-1121
US

IV. Provider business mailing address

7 FRONT ST
WYOMING DE
19934-1121
US

V. Phone/Fax

Practice location:
  • Phone: 302-697-2173
  • Fax: 302-697-3406
Mailing address:
  • Phone: 302-697-2173
  • Fax: 302-697-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU2-0000525
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: