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General NPI Number Information
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NPI Number | 1205307022
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Entity Type | Individual
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Provider Name | TABATHA KAYE ROBERTSON
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 950 CROSS AVE
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City | MADISON
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State | IN
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Zip | 47250-2002
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Country | US
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Telephone | 812-273-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 TILLEY DR
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City | CARROLLTON
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State | KY
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Zip | 41008-9754
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Country | US
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Telephone | 270-970-1982
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32002193A
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License Number State | IN
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