Healthcare Provider Details

I. General information

NPI: 1821134669
Provider Name (Legal Business Name): ROBERT DARYL HOBBS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ROME LN
CORRALES NM
87048-9076
US

IV. Provider business mailing address

107 ROME LN
CORRALES NM
87048-9076
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-4906
  • Fax: 505-265-9146
Mailing address:
  • Phone: 505-265-4906
  • Fax: 505-265-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1147
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: