Healthcare Provider Details

I. General information

NPI: 1124129952
Provider Name (Legal Business Name): ROBIN A SOUTHECORVO OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MEDICAL PARK DRIVE
ASHEVILLE NC
28803-2493
US

IV. Provider business mailing address

18 MEDICAL PARK DRIVE
ASHEVILLE NC
28803-2493
US

V. Phone/Fax

Practice location:
  • Phone: 828-253-7521
  • Fax: 828-251-5992
Mailing address:
  • Phone: 828-253-7521
  • Fax: 828-251-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: