Healthcare Provider Details

I. General information

NPI: 1811196736
Provider Name (Legal Business Name): GARY P ROBERTSON O.T.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S ROCK CRUSHER RD LOT 371
CRYSTAL RIVER FL
34429-5751
US

IV. Provider business mailing address

PO BOX 640277
BEVERLY HILLS FL
34464-0277
US

V. Phone/Fax

Practice location:
  • Phone: 508-274-3321
  • Fax:
Mailing address:
  • Phone: 508-274-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9733
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT9733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: