Healthcare Provider Details

I. General information

NPI: 1508944471
Provider Name (Legal Business Name): ROBIN WYLLIE SP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 QUAKER LN
EAST GREENWICH RI
02818-1667
US

IV. Provider business mailing address

800 QUAKER LN
EAST GREENWICH RI
02818-1667
US

V. Phone/Fax

Practice location:
  • Phone: 401-886-6600
  • Fax: 401-886-6632
Mailing address:
  • Phone: 401-886-6600
  • Fax: 401-886-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP00324
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: