Healthcare Provider Details

I. General information

NPI: 1336080795
Provider Name (Legal Business Name): REBECCA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14811 LAWRENCE 1010
WENTWORTH MO
64873-9320
US

IV. Provider business mailing address

14811 LAWRENCE 1010
WENTWORTH MO
64873-9320
US

V. Phone/Fax

Practice location:
  • Phone: 417-316-0177
  • Fax:
Mailing address:
  • Phone: 417-316-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2025023309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: