Healthcare Provider Details

I. General information

NPI: 1306242250
Provider Name (Legal Business Name): IRINA ROBERTS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRINA POPOVA

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4720
US

IV. Provider business mailing address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4720
US

V. Phone/Fax

Practice location:
  • Phone: 865-394-6612
  • Fax: 865-315-7014
Mailing address:
  • Phone: 865-394-6612
  • Fax: 865-315-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: